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General NPI Number Information
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NPI Number | 1154703460
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Entity Type | Individual
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Provider Name | REBECA LUISA SEGRAVES PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 6364 MARILEE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-8356
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Country | US
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Telephone | 719-270-0155
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Fax | 719-349-5267
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Provider Business Mailing Address
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Address Line | 6364 MARILEE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-8356
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Country | US
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Telephone | 719-270-0155
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Fax | 719-349-5267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2024-0030
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1325234
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0017364
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License Number State | CO
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