Provider Demographics
NPI:1538311931
Name:REBECCA STREET PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REBECCA STREET PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-3368
Mailing Address - Street 1:1210 DRY HOLLOW RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3167
Mailing Address - Country:US
Mailing Address - Phone:541-296-3368
Mailing Address - Fax:541-296-7866
Practice Address - Street 1:1210 DRY HOLLOW RD
Practice Address - Street 2:SUITE 1
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3167
Practice Address - Country:US
Practice Address - Phone:541-296-3368
Practice Address - Fax:541-296-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1879261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy