Provider Demographics
NPI:1861744781
Name:HIRSCHHORN, REBECCA MARIE (ATC, NRAEMT)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARIE
Last Name:HIRSCHHORN
Suffix:
Gender:F
Credentials:ATC, NRAEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 PLEASANT HALL SCHOOL OF KINESIOLOGY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2213 PLEASANT HALL SCHOOL OF KINESIOLOGY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA146M00000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC029679OtherSOUTH CAROLINA DEPT. OF HEALTH AND ENVIRONMENTAL CONTROL
2000009700OtherBOARD OF CERTIFICATION
SC1371OtherSOUTH CAROLINA DEPT. OF HEATH & ENVIRONMENTAL CONTROL
A2027469OtherNATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS