Provider Demographics
NPI:1144380726
Name:PHILLIPS, REBECCA LAUREN (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAUREN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 15TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2145
Mailing Address - Country:US
Mailing Address - Phone:314-249-0844
Mailing Address - Fax:515-989-0195
Practice Address - Street 1:2217 SUNSET BLVD STE 711
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4783
Practice Address - Country:US
Practice Address - Phone:169-435-3500
Practice Address - Fax:916-435-3503
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4197225100000X
CAPT33156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172Medicare PIN
IAI19172008Medicare PIN