Provider Demographics
NPI:1477957959
Name:SMITH, REBBECCA ANN
Entity Type:Individual
Prefix:MRS
First Name:REBBECCA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LUTHER
Mailing Address - State:MI
Mailing Address - Zip Code:49656-8519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10350 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LUTHER
Practice Address - State:MI
Practice Address - Zip Code:49656-8519
Practice Address - Country:US
Practice Address - Phone:231-829-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000555225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant