Provider Demographics
NPI:1821827882
Name:VALENTINE, REBECCA LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:VALENTINE
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 1:371 COLOMA AVE
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9724
Mailing Address - Country:US
Mailing Address - Phone:269-487-6396
Mailing Address - Fax:
Practice Address - Street 1:4336 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-8304
Practice Address - Country:US
Practice Address - Phone:269-487-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501012080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist