Healthcare Provider Details

I. General information

NPI: 1366357451
Provider Name (Legal Business Name): REBECCA ELLIOTT CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

4400 46TH AVE S
MINNEAPOLIS MN
55406-3618
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-3947
  • Fax:
Mailing address:
  • Phone: 317-515-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number85678
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: