Healthcare Provider Details

I. General information

NPI: 1134881634
Provider Name (Legal Business Name): REBECCA L COUTTS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA GUSELLI

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 BOYLSTON ST
BOSTON MA
02116-2848
US

IV. Provider business mailing address

85 CHARLEMONT ST
NEWTON MA
02461-1909
US

V. Phone/Fax

Practice location:
  • Phone: 857-449-7525
  • Fax:
Mailing address:
  • Phone: 978-771-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number23989
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: