Healthcare Provider Details

I. General information

NPI: 1649763533
Provider Name (Legal Business Name): REBECCA MAYPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PINEBROOK RD
VENICE FL
34285-6421
US

IV. Provider business mailing address

6226 AVENTURA DR
SARASOTA FL
34241-9446
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-6733
  • Fax:
Mailing address:
  • Phone: 941-228-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: