Provider Demographics
NPI:1740827575
Name:SOUZA, REBECCA (RPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SOUZA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:30 AVON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3745
Mailing Address - Country:US
Mailing Address - Phone:860-284-9779
Mailing Address - Fax:
Practice Address - Street 1:30 AVON MEADOW LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3745
Practice Address - Country:US
Practice Address - Phone:860-284-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist