Provider Demographics
NPI:1295845451
Name:WILSON, REBECCA JANE (MA, PT)
Entity Type:Individual
Prefix:PROF
First Name:REBECCA
Middle Name:JANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63675 E SADDLEBROOKE BLVD
Mailing Address - Street 2:SUITE R
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1297
Mailing Address - Country:US
Mailing Address - Phone:520-825-8002
Mailing Address - Fax:520-825-8012
Practice Address - Street 1:63675 E SADDLEBROOKE BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1297
Practice Address - Country:US
Practice Address - Phone:520-825-8002
Practice Address - Fax:520-825-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ28115Medicare ID - Type Unspecified