Provider Demographics
NPI:1154457760
Name:ALDRIDGE, REBECCA S D (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S D
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 NW 52ND TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4446
Mailing Address - Country:US
Mailing Address - Phone:352-214-3841
Mailing Address - Fax:
Practice Address - Street 1:1522 NW 52ND TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4446
Practice Address - Country:US
Practice Address - Phone:352-214-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist