Provider Demographics
NPI:1346733664
Name:BOLDEN, REBEKAH (DPT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:JAROSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:STE 200
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:8200 MEADOWBRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2337
Practice Address - Country:US
Practice Address - Phone:804-569-1665
Practice Address - Fax:804-287-2786
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist