Healthcare Provider Details

I. General information

NPI: 1972156917
Provider Name (Legal Business Name): REBECCA LAUREN EDDINGS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 29TH ST STE 102
BOULDER CO
80303-2316
US

IV. Provider business mailing address

777 29TH ST STE 102
BOULDER CO
80303-2316
US

V. Phone/Fax

Practice location:
  • Phone: 303-601-7495
  • Fax: 888-433-8309
Mailing address:
  • Phone: 303-601-7495
  • Fax: 888-433-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016491
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: