MEDICARE: REBECCA PAVLETICH

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1831624998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA PAVLETICH

Provider Business Mailing Address
First Line	:	3721 DRUSO LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-5016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3721 DRUSO LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-5016
Country	:	US
Telephone Number	:	314-630-6114
Fax Number	:

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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Directions to “ REBECCA PAVLETICH ” Practice Location

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