Provider Demographics
NPI:1407011844
Name:MITTENDORF, REBECCA LYNN (MPT)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:LYNN
Last Name:MITTENDORF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 TORREDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1767
Mailing Address - Country:US
Mailing Address - Phone:919-477-4474
Mailing Address - Fax:
Practice Address - Street 1:2059 TORREDGE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1767
Practice Address - Country:US
Practice Address - Phone:919-477-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist