Provider Demographics
NPI:1184473399
Name:MCBRIDE, REBECCA (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SILVERSPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3211
Mailing Address - Country:US
Mailing Address - Phone:631-374-3804
Mailing Address - Fax:
Practice Address - Street 1:128 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2064
Practice Address - Country:US
Practice Address - Phone:631-246-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist