MEDICARE: MRS. REBECCA VAN DYKE SWEEZEY MPT

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	PTH 2995	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-38621	OTHER	AL	CFI BCBS
2	515-38622	OTHER	AL	MCB BCBS
3	510-93981	OTHER	AL	SCR BCBS

General Provider Information

NPI Number	:	1942412010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA VAN DYKE SWEEZEY MPT

Provider Business Mailing Address
First Line	:	3319 DR JOHN HAYNES DR
Second Line	:	STE 4
City	:	PELL CITY
State	:	AL
Zip	:	35125-1583
Country	:	US
Telephone Number	:	205-338-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 DR JOHN HAYNES DR
Second Line	:	STE 4
City	:	PELL CITY
State	:	AL
Zip	:	35125-1583
Country	:	US
Telephone Number	:	205-338-8440
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	02/11/2008

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