Healthcare Provider Details

I. General information

NPI: 1386146413
Provider Name (Legal Business Name): REBECCA N REYNOLDS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA NICHOLE BIBB PT, DPT

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 E SOUTHERN AVE STE 108
MESA AZ
85206-3713
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 480-354-2911
  • Fax: 480-984-3169
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034444
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number034444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: