Provider Demographics
NPI:1124233499
Name:MIKKELSEN, REBEKAH PHILLIPS (RPT)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:PHILLIPS
Last Name:MIKKELSEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORTEGA AVE
Mailing Address - Street 2:UNIT 314
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1500
Mailing Address - Country:US
Mailing Address - Phone:650-428-0564
Mailing Address - Fax:
Practice Address - Street 1:STANFORD UNIVERSITY HOSPITAL
Practice Address - Street 2:PASTEUR DRIVE
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94035
Practice Address - Country:US
Practice Address - Phone:650-723-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist