Provider Demographics
NPI:1023254034
Name:LINDSTROM, REBECCA IRENE (WCMT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:IRENE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:WCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 GOLF TERRACE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-492-0326
Mailing Address - Fax:
Practice Address - Street 1:4330 GOLF TERRACE
Practice Address - Street 2:SUITE 209
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-492-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4149-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist