Provider Demographics
NPI:1336904127
Name:HIETER, REBECCA LYNN (E-RYT500, YACEP BS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:HIETER
Suffix:
Gender:F
Credentials:E-RYT500, YACEP BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:807 W CORBETT AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9039
Mailing Address - Country:US
Mailing Address - Phone:103-253-6009
Mailing Address - Fax:
Practice Address - Street 1:807 W CORBETT AVE STE 8
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9039
Practice Address - Country:US
Practice Address - Phone:910-325-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC171400000X
NC45225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach