Provider Demographics
NPI:1467267617
Name:PEAVLER, REBEKAH LINN (LMT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LINN
Last Name:PEAVLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3058 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6418
Mailing Address - Country:US
Mailing Address - Phone:417-987-6318
Mailing Address - Fax:
Practice Address - Street 1:3058 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6418
Practice Address - Country:US
Practice Address - Phone:417-987-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006037321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist