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NPI Code Detail

MEDICARE: MISS REBECCA LYNN TUDOR PTA

MEDICARE: MISS REBECCA LYNN TUDOR PTA
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 Assistant06004753AIN

General Provider Information

NPI Number : 1477976157
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS REBECCA LYNN TUDOR PTA
Provider Business Mailing Address
First Line : 118 MEDICAL DR
Second Line :
City : CARMEL
State : IN
Zip : 46032-2923
Country : US
Telephone Number : 317-573-1037
Fax Number :
Provider Business Practice Location Address
First Line : 55 WILLOW ST
Second Line :
City : NASHVILLE
State : IN
Zip : 47448-7013
Country : US
Telephone Number : 812-988-6666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2014
Last Update Date : 01/30/2014

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