Healthcare Provider Details

I. General information

NPI: 1003721630
Provider Name (Legal Business Name): REBEKAH VIRGINIA TWIDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W NAVARRE ST STE 6650
SOUTH BEND IN
46601
US

IV. Provider business mailing address

100 W NAVARRE ST STE 6650
SOUTH BEND IN
46601
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-5007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: