Provider Demographics
NPI:1205840717
Name:ADRID, REBECCA A (MPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ADRID
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 OCONNOR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1327
Mailing Address - Country:US
Mailing Address - Phone:585-383-2216
Mailing Address - Fax:
Practice Address - Street 1:41 OCONNOR RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1327
Practice Address - Country:US
Practice Address - Phone:585-383-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30013744OtherKEYSTONE MERCY HEALTH PLA
PA100841476Medicaid
PA1370736OtherBLUE CROSS BLUE SHIELD
PA2425769OtherUNITED HEALTHCARE