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General NPI Number Information
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NPI Number | 1174487896
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Entity Type | Organization
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Legal Business Name | REBELLE THERAPY PLLC
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 2120 1ST AVE N UNIT B10
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City | SEATTLE
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State | WA
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Zip | 98109-2301
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Country | US
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Telephone | 206-414-8115
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 1ST AVE N UNIT B10
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City | SEATTLE
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State | WA
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Zip | 98109-2301
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Country | US
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Telephone | 206-414-8115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE IDA KARDOS
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Credential | DACHM, LAC, LMT
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Telephone | 206-687-5727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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