Provider Demographics
NPI:1710436613
Name:TODD, REBECCA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TODD
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 1:7105 BRANDEN DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8612
Mailing Address - Country:US
Mailing Address - Phone:812-989-4002
Mailing Address - Fax:
Practice Address - Street 1:7105 BRANDEN DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-8612
Practice Address - Country:US
Practice Address - Phone:812-989-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291815225100000X
OHPT016386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist