Provider Demographics
NPI:1417267006
Name:PEACE, REBECCA L (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:PEACE
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-0009
Mailing Address - Country:US
Mailing Address - Phone:409-489-9787
Mailing Address - Fax:409-489-9751
Practice Address - Street 1:1530 SPRINGHILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-9793
Practice Address - Country:US
Practice Address - Phone:409-489-9787
Practice Address - Fax:409-489-9751
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1077576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist