MEDICARE: REBECCA ANNA MAIDANSKY 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1720503188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANNA MAIDANSKY DPT

Provider Business Mailing Address
First Line	:	912 CANNONEER LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1513
Country	:	US
Telephone Number	:	484-269-4454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WESTERN TRAILS BLVD STE 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1601
Country	:	US
Telephone Number	:	512-766-2649
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	02/26/2021

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