Healthcare Provider Details

I. General information

NPI: 1831013317
Provider Name (Legal Business Name): REBEKAH GRACE BEWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CITY WALK WAY APT 103
CHARLOTTESVILLE VA
22902-5548
US

IV. Provider business mailing address

4000 CITY WALK WAY APT 103 103
CHARLOTTESVILLE VA
22902-5548
US

V. Phone/Fax

Practice location:
  • Phone: 703-334-1966
  • Fax:
Mailing address:
  • Phone: 703-334-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: