Provider Demographics
NPI:1851901433
Name:JOHNSON, REBEKAH LINDE (PT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LINDE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:KATHLEEN
Other - Last Name:LINDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8910 N HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3512
Mailing Address - Country:US
Mailing Address - Phone:717-344-7970
Mailing Address - Fax:
Practice Address - Street 1:1601 N TUCSON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3404
Practice Address - Country:US
Practice Address - Phone:520-829-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist