Provider Demographics
NPI:1760928618
Name:MORAN PETIT, REBECCA M (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:MORAN PETIT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 W WARD RD STE 206
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3047
Mailing Address - Country:US
Mailing Address - Phone:410-535-3440
Mailing Address - Fax:301-327-5374
Practice Address - Street 1:3140 W WARD RD STE 206
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3047
Practice Address - Country:US
Practice Address - Phone:410-535-3440
Practice Address - Fax:301-327-5374
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist