Provider Demographics
NPI:1982924130
Name:VINCENT, REBECCA JANE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:JANE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 MCCUTCHEON RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1744
Mailing Address - Country:US
Mailing Address - Phone:423-582-9155
Mailing Address - Fax:
Practice Address - Street 1:6838 MCCUTCHEON RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1744
Practice Address - Country:US
Practice Address - Phone:423-582-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171W00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor