MEDICARE: REBEKAH GREEN

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
1	225200000X	Physical Therapy Assistant	48148	CA

General Provider Information

NPI Number	:	1790346625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH GREEN

Provider Business Mailing Address
First Line	:	4310 PARK NEWPORT
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3187 RED HILL AVE STE 200
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3454
Country	:	US
Telephone Number	:	714-975-8011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	06/21/2019

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Directions to “ REBEKAH GREEN ” Practice Location

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