Provider Demographics
NPI:1720503188
Name:MAIDANSKY, REBECCA ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNA
Last Name:MAIDANSKY
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 1:912 CANNONEER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1513
Mailing Address - Country:US
Mailing Address - Phone:484-269-4454
Mailing Address - Fax:
Practice Address - Street 1:2222 WESTERN TRAILS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1601
Practice Address - Country:US
Practice Address - Phone:512-766-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist