Provider Demographics
NPI:1902473150
Name:ANDERSON, REBECCA NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 KENOSIA AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5909
Mailing Address - Country:US
Mailing Address - Phone:253-216-0949
Mailing Address - Fax:617-420-4141
Practice Address - Street 1:516 KENOSIA AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5909
Practice Address - Country:US
Practice Address - Phone:253-216-0949
Practice Address - Fax:617-420-4141
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60750308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist