Provider Demographics
NPI:1225116171
Name:MCKELVY, REBECCA SUE (MSPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:3935 S LAKE FOREST DR STE 120
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1425
Practice Address - Country:US
Practice Address - Phone:214-495-0763
Practice Address - Fax:214-383-1492
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1170269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T9582OtherBCBS
TX8L18496Medicare PIN