Provider Demographics
NPI:1811197692
Name:WARREN, REBECCA KNIGHT
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KNIGHT
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHARTER OAK LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1035
Mailing Address - Country:US
Mailing Address - Phone:856-596-1218
Mailing Address - Fax:
Practice Address - Street 1:CREEK CROSSING BLVD
Practice Address - Street 2:BLDING 100, STE 107
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:609-265-0700
Practice Address - Fax:609-265-0708
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00849700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist