Provider Demographics
NPI:1770928293
Name:KOLLMORGE, REBECCA LEE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:KOLLMORGE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03862-2210
Mailing Address - Country:US
Mailing Address - Phone:603-964-9425
Mailing Address - Fax:
Practice Address - Street 1:118 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2487
Practice Address - Country:US
Practice Address - Phone:603-580-4494
Practice Address - Fax:603-580-4495
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2586225100000X
MA11878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist