Provider Demographics
NPI:1457583379
Name:SCHALLERT, REBECCA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:SCHALLERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 FARM ROAD 1055
Mailing Address - Street 2:
Mailing Address - City:PURDY
Mailing Address - State:MO
Mailing Address - Zip Code:65734-8789
Mailing Address - Country:US
Mailing Address - Phone:417-235-8770
Mailing Address - Fax:417-235-8780
Practice Address - Street 1:811 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1622
Practice Address - Country:US
Practice Address - Phone:417-235-8770
Practice Address - Fax:417-235-8780
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008026269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist