Provider Demographics
NPI:1952415051
Name:STAMP, REBEKAH JEAN (MSPT)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JEAN
Last Name:STAMP
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 4TH ST
Mailing Address - Street 2:#A2
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2400
Mailing Address - Country:US
Mailing Address - Phone:406-363-2494
Mailing Address - Fax:406-363-7232
Practice Address - Street 1:117 N 4TH ST
Practice Address - Street 2:#A2
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2400
Practice Address - Country:US
Practice Address - Phone:406-363-2494
Practice Address - Fax:406-363-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1493 PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061871OtherBCBS
MT0036309Medicaid
MT000061871OtherBCBS