Healthcare Provider Details

I. General information

NPI: 1417539933
Provider Name (Legal Business Name): REBECCA A WHITE PT, DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA A WILLIAMS

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7390 W EASTMAN PL
LAKEWOOD CO
80227-5039
US

IV. Provider business mailing address

19468 W 52ND DR
GOLDEN CO
80403-2171
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-2848
  • Fax:
Mailing address:
  • Phone: 303-717-1072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPTL.0012700
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: