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General NPI Number Information
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NPI Number | 1740690007
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Entity Type | Individual
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Provider Name | REBECCA BAIRD-JOHNSON L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 8761 US HIGHWAY 42 SUITE B
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City | UNION
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State | KY
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Zip | 41091-9315
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Country | US
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Telephone | 859-647-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W 10TH ST
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City | NEWPORT
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State | KY
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Zip | 41071-1448
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Country | US
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Telephone | 859-750-6929
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | KY-4239
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License Number State | KY
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