Provider Demographics
NPI:1255317764
Name:KANE, REBECCA V (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:V
Last Name:KANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:W
Other - Last Name:VANDERZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:500 FEDERAL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2832
Mailing Address - Country:US
Mailing Address - Phone:518-272-3324
Mailing Address - Fax:518-274-6904
Practice Address - Street 1:500 FEDERAL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2832
Practice Address - Country:US
Practice Address - Phone:518-272-3324
Practice Address - Fax:518-274-6904
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
017676OtherLICENSE
NY5573641OtherAETNA PPO
NYQ28771OtherEMPIRE BC
NY2023570OtherAETNA HMO
NY000406370001OtherBLUE SHIELD
NY10025385OtherCDPHP
NY43050OtherMVP
NY650020454OtherRAILROAD MEDICARE
NY5573641OtherAETNA PPO