Provider Demographics
NPI:1952562878
Name:HAYES, REBECCA NICOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NICOLE
Last Name:HAYES
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 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:503-443-6156
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:23505 E APPLEWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-891-2258
Practice Address - Fax:509-891-2094
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5676225100000X
WAPT60446650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952562878Medicaid
WAP01451146OtherRR MEDICARE
WA0329760OtherWA L&I
WAG8933771Medicare PIN