Provider Demographics
NPI:1407190887
Name:NIDDRIE, REBECCA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:NIDDRIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SUNDERLAND RD
Mailing Address - Street 2:APT 4A
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2527
Mailing Address - Country:US
Mailing Address - Phone:774-239-5463
Mailing Address - Fax:
Practice Address - Street 1:376 SUNDERLAND RD
Practice Address - Street 2:APT 4A
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2527
Practice Address - Country:US
Practice Address - Phone:774-239-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist