Healthcare Provider Details

I. General information

NPI: 1871053322
Provider Name (Legal Business Name): REBECCA A. GRAVES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA A. BOYER PT

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

IV. Provider business mailing address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-7570
  • Fax: 360-416-7580
Mailing address:
  • Phone: 360-416-7570
  • Fax: 360-416-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: