Provider Demographics
NPI:1144587940
Name:FISH, REBECCA EVE (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EVE
Last Name:FISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROSEMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1968
Mailing Address - Country:US
Mailing Address - Phone:508-889-2652
Mailing Address - Fax:
Practice Address - Street 1:9 ROSEMEADOW CT
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-1968
Practice Address - Country:US
Practice Address - Phone:508-889-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8592225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant