Provider Demographics
NPI:1659821304
Name:HORGAN, REBEKAH MARIE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:REBEKAH
Middle Name:MARIE
Last Name:HORGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4511
Mailing Address - Country:US
Mailing Address - Phone:701-320-5404
Mailing Address - Fax:
Practice Address - Street 1:1432 POCATELLO DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6450
Practice Address - Country:US
Practice Address - Phone:701-320-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist