Provider Demographics
NPI:1740690007
Name:BAIRD-JOHNSON, REBECCA (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BAIRD-JOHNSON
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 1:235 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1448
Mailing Address - Country:US
Mailing Address - Phone:859-750-6929
Mailing Address - Fax:
Practice Address - Street 1:8761 US HIGHWAY 42
Practice Address - Street 2:SUITE B
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-9315
Practice Address - Country:US
Practice Address - Phone:859-647-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-4239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist