Provider Demographics
NPI:1548383409
Name:PAQUETTE, REBECCA ALICE (PT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ALICE
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ALICE
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4654 BALBOA PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4960
Mailing Address - Country:US
Mailing Address - Phone:404-376-4443
Mailing Address - Fax:
Practice Address - Street 1:11161 STATE ROAD 70 E STE 110-124
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-9407
Practice Address - Country:US
Practice Address - Phone:404-376-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006365225100000X
FLPT299622251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology