Provider Demographics
NPI:1902179831
Name:MASSMANN, REBECCA S
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:MASSMANN
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 1:600 HIGHLAND AVE
Mailing Address - Street 2:MC 2433
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-1530
Mailing Address - Country:US
Mailing Address - Phone:608-662-0817
Mailing Address - Fax:608-203-4544
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:MC 2433
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-1530
Practice Address - Country:US
Practice Address - Phone:608-662-0817
Practice Address - Fax:608-203-4544
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1075-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist