Provider Demographics
NPI:1518381540
Name:DUBE, REBECCA EDITH (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:EDITH
Last Name:DUBE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 CROWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989-3602
Mailing Address - Country:US
Mailing Address - Phone:207-314-7432
Mailing Address - Fax:
Practice Address - Street 1:273 CROWELL HILL RD
Practice Address - Street 2:
Practice Address - City:VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04989-3602
Practice Address - Country:US
Practice Address - Phone:207-314-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3678225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant