Provider Demographics
NPI:1265861231
Name:BUSENBARK, REBECCA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BUSENBARK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:HOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 643407
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-3407
Mailing Address - Country:US
Mailing Address - Phone:800-721-8202
Mailing Address - Fax:
Practice Address - Street 1:401 E COLFAX AVE STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-234-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013335A225100000X
AZ10636PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist