Provider Demographics
NPI:1336873348
Name:THROCKMORTON, REBECCA (PRS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:THROCKMORTON
Suffix:
Gender:F
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 US HIGHWAY 22 NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-8604
Mailing Address - Country:US
Mailing Address - Phone:740-335-7282
Mailing Address - Fax:
Practice Address - Street 1:1400 US HIGHWAY 22 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-8604
Practice Address - Country:US
Practice Address - Phone:740-335-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002788175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist