Provider Demographics
NPI:1841249356
Name:NEWBY, REBECCA J (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:NEWBY
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 1:1200 OAKLEAF WAY STE B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-839-9266
Mailing Address - Fax:715-839-8761
Practice Address - Street 1:1200 OAKLEAF WAY STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-839-9266
Practice Address - Fax:715-839-8761
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4042024225100000X
WI1938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI48284300Medicaid
WI48284300Medicaid
845870013Medicare UPIN
0148340001Medicare NSC