Provider Demographics
NPI:1417143801
Name:BARON, REBECCA A (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BARON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1375
Mailing Address - Country:US
Mailing Address - Phone:608-417-8250
Mailing Address - Fax:608-287-2360
Practice Address - Street 1:1 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1375
Practice Address - Country:US
Practice Address - Phone:608-417-8250
Practice Address - Fax:608-287-2360
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist