Provider Demographics
NPI:1952045155
Name:LUNDGREN, REBECCA FRANCES (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FRANCES
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 MASON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4764
Mailing Address - Country:US
Mailing Address - Phone:415-408-8656
Mailing Address - Fax:
Practice Address - Street 1:302 SILVER AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1510
Practice Address - Country:US
Practice Address - Phone:415-334-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist