Provider Demographics
NPI:1922545466
Name:MEDBERY, REBECCA CRICKET (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:CRICKET
Last Name:MEDBERY
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1409
Mailing Address - Country:US
Mailing Address - Phone:860-377-9423
Mailing Address - Fax:
Practice Address - Street 1:10 HIGGINS HWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-3772
Practice Address - Fax:860-456-4941
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010658225100000X
CT0011052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer