Provider Demographics
NPI:1477503225
Name:KIKER, REBECCA L (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:KIKER
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 1:611 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7544
Mailing Address - Country:US
Mailing Address - Phone:254-776-3070
Mailing Address - Fax:254-776-7909
Practice Address - Street 1:611 W STATE HIGHWAY 6
Practice Address - Street 2:SUITE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7544
Practice Address - Country:US
Practice Address - Phone:254-776-3070
Practice Address - Fax:254-776-7909
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4295OtherBLUE CROSS BLUE SHIELD
TX8T4295OtherBLUE CROSS BLUE SHIELD