Provider Demographics
NPI:1649988767
Name:FAILS, REBECCA ANNE FALLUCCA (DPT)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE FALLUCCA
Last Name:FAILS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 COPPOLA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8069
Mailing Address - Country:US
Mailing Address - Phone:407-285-9215
Mailing Address - Fax:
Practice Address - Street 1:437 WEST ARDICE AVENUE
Practice Address - Street 2:SUITE 481
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-747-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist