Provider Demographics
NPI:1902112733
Name:PICKERING, REBECCA T (LMT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:T
Last Name:PICKERING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 US HIGHWAY 1
Mailing Address - Street 2:SUITE #5
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5703
Mailing Address - Country:US
Mailing Address - Phone:772-794-5200
Mailing Address - Fax:
Practice Address - Street 1:1360 US HIGHWAY 1
Practice Address - Street 2:SUITE #5
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5703
Practice Address - Country:US
Practice Address - Phone:772-794-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0021508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist