Healthcare Provider Details

I. General information

NPI: 1699759084
Provider Name (Legal Business Name): REBECCA C SMITH D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ROCHE BROS WAY
NORTH EASTON MA
02356
US

IV. Provider business mailing address

PO BOX 30
STOUGHTON MA
02072-0030
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-3535
  • Fax: 508-535-0192
Mailing address:
  • Phone: 781-344-3535
  • Fax: 508-535-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: