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NPI Code Detail

MEDICARE: REBECCA STAPLES PT, DPT

MEDICARE: REBECCA STAPLES PT, DPT
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
12251G0304XGeriatric Physical TherapistPT34189FL
2225100000XPhysical Therapist18037MA
32251G0304XGeriatric Physical Therapist63645OR

General Provider Information

NPI Number : 1659502557
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA STAPLES PT, DPT
Provider Business Mailing Address
First Line : 3738 SW PATTON RD
Second Line :
City : PORTLAND
State : OR
Zip : 97221-4128
Country : US
Telephone Number : 503-680-9425
Fax Number :
Provider Business Practice Location Address
First Line : 1902 59TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34209-4602
Country : US
Telephone Number : 941-761-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2009
Last Update Date : 12/02/2024

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