Provider Demographics
NPI:1427193861
Name:HENDRICKSON, REBECCA ANN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:RUMOVICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 WIDOW SWEETS RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-3131
Mailing Address - Country:US
Mailing Address - Phone:186-046-3757
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1006
Practice Address - Country:US
Practice Address - Phone:401-841-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002762255A2300X
RIAT002592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer