Basic Information
| Provider Information | |||||||||
| NPI: | 1629283700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EAGLEEYE | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | STE 365 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002971479 | ||||||||
| FaxNumber: | 8668482496 | ||||||||
| Practice Location | |||||||||
| Address1: | 16600 W SPRAGUE RD | ||||||||
| Address2: | STE 365 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441306318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002971479 | ||||||||
| FaxNumber: | 8668482496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070013666 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 010190 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.