Provider Demographics
NPI:1801347935
Name:CRITELLI, REBECCA LYNNE (DPT, PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:CRITELLI
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LYNNE
Other - Last Name:WETTLAUFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT PT
Mailing Address - Street 1:461 POND APPLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2208
Mailing Address - Country:US
Mailing Address - Phone:716-997-2962
Mailing Address - Fax:
Practice Address - Street 1:461 POND APPLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2208
Practice Address - Country:US
Practice Address - Phone:716-997-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist