Provider Demographics
NPI:1578758082
Name:MCALLISTER, REBECCA M (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:MCALLISTER
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:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088-1202
Mailing Address - Country:US
Mailing Address - Phone:210-867-4506
Mailing Address - Fax:
Practice Address - Street 1:107 EAGLE RIDGE TRCE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-4512
Practice Address - Country:US
Practice Address - Phone:210-867-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79256724Medicaid
AZ260831Medicaid
PENDINGMedicare PIN
320059Medicare Oscar/Certification