Healthcare Provider Details

I. General information

NPI: 1043126493
Provider Name (Legal Business Name): REBECCA ROE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 WASHINGTON AVE STE 100
ALBANY NY
12206-1043
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 209
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-1667
  • Fax:
Mailing address:
  • Phone: 518-786-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: