Provider Demographics
NPI:1922792944
Name:COLMENARES, REBECCA (CLMT)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:COLMENARES
Suffix:
Gender:F
Credentials:CLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-8907
Mailing Address - Country:US
Mailing Address - Phone:520-302-0970
Mailing Address - Fax:
Practice Address - Street 1:6700 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7732
Practice Address - Country:US
Practice Address - Phone:520-302-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23083225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172M00000XMedicaid
AZ225700000XMedicaid