Healthcare Provider Details

I. General information

NPI: 1386146413
Provider Name (Legal Business Name): REBECCA NICHOLE 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: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 S LAKESHORE DR STE 2
TEMPE AZ
85282-7159
US

IV. Provider business mailing address

4703 S LAKESHORE DR STE 2
TEMPE AZ
85282-7159
US

V. Phone/Fax

Practice location:
  • Phone: 480-718-9493
  • Fax:
Mailing address:
  • Phone: 480-718-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number034444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: