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General NPI Number Information
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NPI Number | 1205595246
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Entity Type | Individual
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Provider Name | REBECCA PROWS PTA
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 45-181 WAIKALUA RD
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City | KANEOHE
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State | HI
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Zip | 96744-2765
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Country | US
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Telephone | 808-247-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 PELICAN CV
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City | GULFPORT
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State | MS
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Zip | 39501-3710
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Country | US
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Telephone | 954-756-2691
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-473
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License Number State | HI
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