Healthcare Provider Details

I. General information

NPI: 1093899502
Provider Name (Legal Business Name): REBECCA ANNE MCFADDEN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10587 DOUBLE R BLVD
RENO NV
89521-8909
US

IV. Provider business mailing address

PO BOX 7523
TAHOE CITY CA
96145-7523
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-5371
  • Fax: 775-852-5373
Mailing address:
  • Phone: 530-581-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0688
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number16414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: