Provider Demographics
NPI:1518935659
Name:BAIRD, REBECCA LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:BAIRD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:WOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3656 SERENDIPITY LN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4956
Mailing Address - Country:US
Mailing Address - Phone:605-791-1609
Mailing Address - Fax:
Practice Address - Street 1:3656 SERENDIPITY LN
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4956
Practice Address - Country:US
Practice Address - Phone:605-791-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3131710OtherBLUE CROSS BLUE SHIELD
WY121908100Medicaid
SD4992931OtherBC/BS
WYP00235134OtherRAILROAD MEDICARE
WY3131710OtherBLUE CROSS BLUE SHIELD
WYW20424Medicare ID - Type Unspecified
WY121908100Medicaid