Provider Demographics
NPI:1902259336
Name:BALDRIDGE, REBECCA (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:HUFFAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 CENTER WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4239
Practice Address - Country:US
Practice Address - Phone:979-848-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2124296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant