Provider Demographics
NPI:1922525179
Name:TAYLOR, REBECCA J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 E WABASH ST STE 100
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-9400
Practice Address - Country:US
Practice Address - Phone:765-659-7400
Practice Address - Fax:765-659-7408
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012647A225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300015397Medicaid