Provider Demographics
NPI:1215231139
Name:TAYLOR, REBECCA SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1612 E SHARPSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-8706
Mailing Address - Country:US
Mailing Address - Phone:509-443-2627
Mailing Address - Fax:
Practice Address - Street 1:1612 E SHARPSBURG AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-8706
Practice Address - Country:US
Practice Address - Phone:509-443-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist