Provider Demographics
NPI:1699847699
Name:BADGEROW-WATSON, REBECCA (MPT,OCS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BADGEROW-WATSON
Suffix:
Gender:F
Credentials:MPT,OCS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BADGEROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT,OCS
Mailing Address - Street 1:236 SOUTHWOODS CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2462
Mailing Address - Country:US
Mailing Address - Phone:618-281-0374
Mailing Address - Fax:618-281-0674
Practice Address - Street 1:236 SOUTHWOODS CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2462
Practice Address - Country:US
Practice Address - Phone:618-281-0374
Practice Address - Fax:618-281-0674
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
277645OtherGHP
5660579OtherFIRST HEALTH CCN
K23120OtherMERCY
06732025OtherBCBS OF IL
7361646OtherAETNA
737359OtherHEALTHLINK
9419162OtherPHCS
205903OtherBCBS OF MO
13897OtherESSENCE HEALTHCARE
277645OtherGHP