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NPI Code Detail

MEDICARE: REBECCA FORTUNE

MEDICARE:   REBECCA  FORTUNE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant6688NC

General Provider Information

NPI Number : 1437624707
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA FORTUNE
Provider Business Mailing Address
First Line : 289 CORONA CIR
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-4380
Country : US
Telephone Number : 704-953-5268
Fax Number :
Provider Business Practice Location Address
First Line : 102 LEONARD AVE
Second Line :
City : NEWTON
State : NC
Zip : 28658-9649
Country : US
Telephone Number : 877-637-7941
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2018
Last Update Date : 10/12/2018

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Directions to “ REBECCA FORTUNE ” Practice Location

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