Provider Demographics
NPI:1215017157
Name:MOONEN, REBECCA LYNN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:MOONEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:FARLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52046-9613
Mailing Address - Country:US
Mailing Address - Phone:563-580-7819
Mailing Address - Fax:
Practice Address - Street 1:2035 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2478
Practice Address - Country:US
Practice Address - Phone:563-326-1400
Practice Address - Fax:563-326-0700
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist