Provider Demographics
NPI:1922354455
Name:MANDEL, REBECCA NATALIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:NATALIE
Last Name:MANDEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHAMPNEY ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1614
Mailing Address - Country:US
Mailing Address - Phone:847-347-2029
Mailing Address - Fax:
Practice Address - Street 1:8 CHAMPNEY ST
Practice Address - Street 2:APT 1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1614
Practice Address - Country:US
Practice Address - Phone:847-347-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9698225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist