Provider Demographics
NPI:1275593741
Name:WING, REBECCA J (MPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:WING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1581 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1232
Mailing Address - Country:US
Mailing Address - Phone:413-283-8303
Mailing Address - Fax:413-283-8304
Practice Address - Street 1:1581 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1232
Practice Address - Country:US
Practice Address - Phone:413-283-8303
Practice Address - Fax:413-283-8304
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7112225100000X, 2251G0304X, 225400000X, 2251N0400X, 2251S0007X, 2251X0800X
MA16031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT764750001OtherCIGNA GRP #
CTCONN605700112OtherPRIVATEHLTHCARESYS GRP#
CT080007112CT01OtherANTHEM:REBECCAJ.ANDERSON
CTANC1648OtherOXFORD GRP #
CTC009365OtherCHAMPUS GRP #
CT119457OtherAETNA GRP #
CTCT154333OtherPREFEREEDHLTHNETWRK GRP#
CT061090356OtherFEDERAL TAX ID#
CTOV1296OtherHEALTHNET GRP #
CT061090356OtherCIGNA ORTHONET GRP #
CTANC1648OtherOXFORD GRP #
CT650000927Medicare ID - Type UnspecifiedREBECCAJANDERSON ID#