Provider Demographics
NPI:1558864074
Name:BUSSELL, REBECCA E
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:BUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2725
Mailing Address - Country:US
Mailing Address - Phone:203-885-4621
Mailing Address - Fax:
Practice Address - Street 1:1 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-2725
Practice Address - Country:US
Practice Address - Phone:203-885-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-11
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13691225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer