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General NPI Number Information
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NPI Number | 1861789703
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Entity Type | Individual
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Provider Name | REBEKA M PHILLIPS L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 105 WALL ST 1ST FLOOR - CAROL WEDDLE'S OFFICE
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City | POTEAU
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State | OK
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Zip | 74953-4433
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Country | US
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Telephone | 479-883-3198
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 S WALTON BLVD STE 101
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City | BENTONVILLE
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State | AR
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Zip | 72712-6120
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Country | US
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Telephone | 479-883-3198
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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 | 7035
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License Number State | AR
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