Provider Demographics
NPI:1821360785
Name:ANHOLD, REBECCA C (VATL, ATC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:C
Last Name:ANHOLD
Suffix:
Gender:F
Credentials:VATL, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FORT DEFIANCE RD
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:VA
Mailing Address - Zip Code:24421
Mailing Address - Country:US
Mailing Address - Phone:540-245-5050
Mailing Address - Fax:
Practice Address - Street 1:195 FORT DEFIANCE RD
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:VA
Practice Address - Zip Code:24437-2001
Practice Address - Country:US
Practice Address - Phone:540-245-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAJ040801501146N00000X
VA0126000099246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic