Provider Demographics
NPI:1124564182
Name:DREW, REBECCA HALEY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HALEY
Last Name:DREW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 NORTHWOOD WEST DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2260
Mailing Address - Country:US
Mailing Address - Phone:662-902-3892
Mailing Address - Fax:
Practice Address - Street 1:421 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2348
Practice Address - Country:US
Practice Address - Phone:662-449-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist