Provider Demographics
NPI:1821114679
Name:SLOCUM, REBECCA LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SLOCUM
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 1:2 MOUNTAINVIEW TER
Mailing Address - Street 2:APPT. #1331
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4163
Mailing Address - Country:US
Mailing Address - Phone:716-864-5753
Mailing Address - Fax:
Practice Address - Street 1:177 WHITEWOOD RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1545
Practice Address - Country:US
Practice Address - Phone:716-864-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029094225100000X
MD22179225100000X
PAPT018696225100000X
CT008114225100000X
FL23783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist