Healthcare Provider Details

I. General information

NPI: 1427386770
Provider Name (Legal Business Name): REBEKAH RUTH ALDRIDGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 E MAIN ST SUITE 7
GRANTSVILLE UT
84029-2500
US

IV. Provider business mailing address

822 E MAIN ST SUITE 7
GRANTSVILLE UT
84029-2500
US

V. Phone/Fax

Practice location:
  • Phone: 435-884-3578
  • Fax: 435-884-3582
Mailing address:
  • Phone: 435-884-3578
  • Fax: 435-884-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number74919181206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: