Provider Demographics
NPI:1467408096
Name:DYCHES, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DYCHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DYCHES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MS
Mailing Address - Street 1:311 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2975
Mailing Address - Country:US
Mailing Address - Phone:843-553-7676
Mailing Address - Fax:843-553-7747
Practice Address - Street 1:311 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2975
Practice Address - Country:US
Practice Address - Phone:843-553-7676
Practice Address - Fax:843-553-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ34306Medicare UPIN
SCQ343068665Medicare PIN