Provider Demographics
NPI:1821734625
Name:CHEEMA, REBECCA L (PTA ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:CHEEMA
Suffix:
Gender:F
Credentials:PTA ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N EL CAMINO REAL APT 203
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3776
Mailing Address - Country:US
Mailing Address - Phone:650-425-9672
Mailing Address - Fax:
Practice Address - Street 1:2121 S EL CAMINO REAL STE B200
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1857
Practice Address - Country:US
Practice Address - Phone:650-425-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8217152255A2300X
CA50457225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer