Healthcare Provider Details

I. General information

NPI: 1245436708
Provider Name (Legal Business Name): REBEKAH DONLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH REIFSNYDER DPT

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 S HIGHWAY 89
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 8467
JACKSON WY
83002-8467
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-5577
  • Fax: 307-733-5505
Mailing address:
  • Phone: 307-733-5577
  • Fax: 307-733-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33729
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1388
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: