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General NPI Number Information
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NPI Number | 1922545466
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Entity Type | Individual
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Provider Name | REBECCA CRICKET MEDBERY DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 10 HIGGINS HWY SUITE 12
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1437
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Country | US
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Telephone | 860-456-3772
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Fax | 860-456-4941
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Provider Business Mailing Address
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Address Line | 281 COVENTRY RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1409
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Country | US
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Telephone | 860-377-9423
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 010658
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001105
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License Number State | CT
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