Healthcare Provider Details

I. General information

NPI: 1093356958
Provider Name (Legal Business Name): REBECCA LAUREN STRUBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E MARSHALL ST
WEST CHESTER PA
19380-4412
US

IV. Provider business mailing address

701 E MARSHALL STREET
WEST CHESTER PA
19380-4412
US

V. Phone/Fax

Practice location:
  • Phone: 610-431-5000
  • Fax: 610-431-5025
Mailing address:
  • Phone: 610-431-5000
  • Fax: 610-431-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA005049
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061161
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: