Provider Demographics
NPI:1063532729
Name:GREATHOUSE, REBECCA M (MPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 MAHONING AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2239
Mailing Address - Country:US
Mailing Address - Phone:330-755-3000
Mailing Address - Fax:330-755-3300
Practice Address - Street 1:6006 MAHONING AVE
Practice Address - Street 2:SUITE G
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2239
Practice Address - Country:US
Practice Address - Phone:330-755-3000
Practice Address - Fax:330-755-3300
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist