Provider Demographics
NPI:1801855705
Name:KLUG, REBECCA LEE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:KLUG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:LEE
Other - Last Name:KLUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:CA
Mailing Address - Zip Code:95703-0615
Mailing Address - Country:US
Mailing Address - Phone:530-878-6950
Mailing Address - Fax:
Practice Address - Street 1:250 ELM AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4226
Practice Address - Country:US
Practice Address - Phone:530-889-2411
Practice Address - Fax:530-889-2451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist