Provider Demographics
NPI:1437242989
Name:PROIETTI, REBECCA S (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:PROIETTI
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CARRIER WELLNESS CENTER - BLDG. TR-19
Mailing Address - Street 2:PO BOX 4808
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13221
Mailing Address - Country:US
Mailing Address - Phone:315-432-7500
Mailing Address - Fax:315-432-6244
Practice Address - Street 1:6304 THOMPSON ROAD
Practice Address - Street 2:CARRIER WELLNESS CENTER - BLDG. TR-19
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206
Practice Address - Country:US
Practice Address - Phone:315-432-7500
Practice Address - Fax:315-432-6244
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021175-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22-3785768OtherTIN
NY22-3785768OtherTIN