Healthcare Provider Details

I. General information

NPI: 1710537774
Provider Name (Legal Business Name): REBECCA REIBEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 POINTE TREMBLE RD
ALGONAC MI
48001-4641
US

IV. Provider business mailing address

3207 POINTE TREMBLE RD
ALGONAC MI
48001-4641
US

V. Phone/Fax

Practice location:
  • Phone: 586-995-2931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: