Provider Demographics
NPI:1558492280
Name:SCANNALIATO, REBECCA A (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:SCANNALIATO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 CLIFF CREST DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5881
Mailing Address - Country:US
Mailing Address - Phone:770-617-0289
Mailing Address - Fax:
Practice Address - Street 1:1401 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 380
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6495
Practice Address - Country:US
Practice Address - Phone:770-565-9393
Practice Address - Fax:770-565-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCTNMedicare ID - Type UnspecifiedMEDICARE
GAQ32958Medicare UPIN