Provider Demographics
NPI:1952376998
Name:MCCOLLAM, REBECCA LYNNE (PT,MSA,OCS,CERTMDT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNNE
Last Name:MCCOLLAM
Suffix:
Gender:F
Credentials:PT,MSA,OCS,CERTMDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINCKNEY BLVD
Mailing Address - Street 2:NAVAL HOSPITAL BEAUFORT
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902
Mailing Address - Country:US
Mailing Address - Phone:843-228-5600
Mailing Address - Fax:
Practice Address - Street 1:1 PINCKNEY BLVD.
Practice Address - Street 2:NAVAL HOSPITAL BEAUFORT
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-228-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0084912251X0800X
SC51142251X0800X
PAPT005680L2251X0800X
FLPT261192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic