Healthcare Provider Details

I. General information

NPI: 1659502557
Provider Name (Legal Business Name): REBECCA STAPLES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 59TH ST W
BRADENTON FL
34209-4602
US

IV. Provider business mailing address

3738 SW PATTON RD
PORTLAND OR
97221-4128
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-1000
  • Fax:
Mailing address:
  • Phone: 503-680-9425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT34189
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18037
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number63645
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: