Healthcare Provider Details

I. General information

NPI: 1629927470
Provider Name (Legal Business Name): REBECCA L BERCOVITCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LOMA COLORADO BLVD NE
RIO RANCHO NM
87124-6524
US

IV. Provider business mailing address

349 PLAYFUL MEADOWS DR NE
RIO RANCHO NM
87144-4120
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-2296
  • Fax:
Mailing address:
  • Phone: 505-463-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1933
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: