Provider Demographics
NPI:1447402169
Name:TARBERT, REBECCA JAYNE (MPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JAYNE
Last Name:TARBERT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STREET RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4250
Mailing Address - Country:US
Mailing Address - Phone:215-675-4466
Mailing Address - Fax:
Practice Address - Street 1:1111 STREET RD
Practice Address - Street 2:SUITE104
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4250
Practice Address - Country:US
Practice Address - Phone:215-675-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012804L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist