Provider Demographics
NPI:1568241636
Name:GILES, REBECCA RUTH-LABASTIDA (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH-LABASTIDA
Last Name:GILES
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 1:49650 CHERRY HILL RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4860
Mailing Address - Country:US
Mailing Address - Phone:344-953-7257
Mailing Address - Fax:734-495-3734
Practice Address - Street 1:49650 CHERRY HILL RD STE 230
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4860
Practice Address - Country:US
Practice Address - Phone:344-953-7257
Practice Address - Fax:734-495-3734
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist