Provider Demographics
NPI:1275951642
Name:EISEN, REBECCA CARRIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CARRIE
Last Name:EISEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:CARRIE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1001
Mailing Address - Country:US
Mailing Address - Phone:770-974-7494
Mailing Address - Fax:
Practice Address - Street 1:3450 ACWORTH DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1001
Practice Address - Country:US
Practice Address - Phone:770-974-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist