Provider Demographics
NPI:1205229812
Name:KUMAR, REBECCA LYNN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:KUMAR
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 S FENMORE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:MI
Mailing Address - Zip Code:48637-9770
Mailing Address - Country:US
Mailing Address - Phone:989-780-0887
Mailing Address - Fax:
Practice Address - Street 1:3545 S FENMORE RD
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:MI
Practice Address - Zip Code:48637-9770
Practice Address - Country:US
Practice Address - Phone:989-780-0887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003865225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant