Basic Information
| Provider Information | |||||||||
| NPI: | 1922119585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1403 MILL RACE DRIVE | ||||||||
| Address2: | HEARTLAND REHABILITATION SERVICES | ||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404440526 | ||||||||
| FaxNumber: | 5404440531 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 MILL LN | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241533102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403874311 | ||||||||
| FaxNumber: | 5403896212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| 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 | 2305001537 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.