Provider Demographics
NPI:1508423203
Name:ROCKENHAUS, REBECCA (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROCKENHAUS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 N STEELE BLVD STE 80
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5394
Mailing Address - Country:US
Mailing Address - Phone:479-422-9404
Mailing Address - Fax:
Practice Address - Street 1:4155 N STEELE BLVD STE 80
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5394
Practice Address - Country:US
Practice Address - Phone:479-422-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer