Provider Demographics
NPI:1245721299
Name:CARRELL, REBECCA RENAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RENAE
Last Name:CARRELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2525
Mailing Address - Country:US
Mailing Address - Phone:321-430-0551
Mailing Address - Fax:407-641-9707
Practice Address - Street 1:1103 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:321-430-0551
Practice Address - Fax:407-641-9707
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33583208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation