Provider Demographics
NPI:1700226677
Name:THOM, REBECCA RAE (LMT, CMT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:RAE
Last Name:THOM
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 HAMNER AVE STE G
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2674
Mailing Address - Country:US
Mailing Address - Phone:951-736-8079
Mailing Address - Fax:951-736-9695
Practice Address - Street 1:2395 HAMNER AVE STE G
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2674
Practice Address - Country:US
Practice Address - Phone:951-736-8079
Practice Address - Fax:951-736-9695
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24487172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist