Provider Demographics
NPI:1518437078
Name:TAYLOR, REBECCA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KOVALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:25 CANIDAE CT
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7639
Mailing Address - Country:US
Mailing Address - Phone:732-677-6897
Mailing Address - Fax:
Practice Address - Street 1:25 CANIDAE CT
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7639
Practice Address - Country:US
Practice Address - Phone:732-677-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01808900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist