Basic Information
| Provider Information | |||||||||
| NPI: | 1720147549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINDOE | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2064 NALONE E | ||||||||
| Address2: | |||||||||
| City: | WIXOM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483931331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489262576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11060 HI TECH DR | ||||||||
| Address2: | LEAPS AND BOUNDS THERAPY SERVICES | ||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344494649 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 5501011498 | MI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | 5501011498 | MI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.