Provider Demographics
NPI:1669640678
Name:WHITEHILL, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WHITEHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:FAYE
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 PETERS CREEK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3894
Mailing Address - Country:US
Mailing Address - Phone:540-366-2711
Mailing Address - Fax:540-366-0047
Practice Address - Street 1:5450 PETERS CREEK RD STE 111
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3894
Practice Address - Country:US
Practice Address - Phone:540-366-2711
Practice Address - Fax:540-366-0047
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013263441Medicaid