Provider Demographics
NPI:1841968955
Name:DAVID, REBECCA RENE (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RENE
Last Name:DAVID
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 COACHMAN CT APT D
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-8576
Mailing Address - Country:US
Mailing Address - Phone:719-252-4235
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE OF CHAMPIONS
Practice Address - Street 2:ROOM 1820 DIDDLE ARENA
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-745-3743
Practice Address - Fax:270-745-3409
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTCA0112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer