MEDICARE: REBEKAH MUIR PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	8596707-2402	UT
2	225200000X	Physical Therapy Assistant	P260936336	WA

General Provider Information

NPI Number	:	1366909517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH MUIR PTA

Provider Business Mailing Address
First Line	:	1233 SW CARVER ST
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 SE MYRA RD
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1796
Country	:	US
Telephone Number	:	509-529-4480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	03/05/2019

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Directions to “ REBEKAH MUIR PTA” Practice Location

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