Provider Demographics
NPI:1831965086
Name:MEDIN, REBECCA LYNNE (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:MEDIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6214
Mailing Address - Country:US
Mailing Address - Phone:303-803-5869
Mailing Address - Fax:
Practice Address - Street 1:760 E BEDFORD DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-6214
Practice Address - Country:US
Practice Address - Phone:303-803-5869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist