Provider Demographics
NPI:1700212594
Name:XIONG, REBECCA BEAUDRY (DPT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:BEAUDRY
Last Name:XIONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:BEAUDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1320 WALLACE RD NW
Mailing Address - Street 2:APT 33
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3083
Mailing Address - Country:US
Mailing Address - Phone:971-998-6694
Mailing Address - Fax:
Practice Address - Street 1:1320 WALLACE RD NW
Practice Address - Street 2:APT 33
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3083
Practice Address - Country:US
Practice Address - Phone:971-998-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist