Provider Demographics
NPI:1124296785
Name:CAREY, REBECCA R (NCTMB, LMT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:CAREY
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3752
Mailing Address - Country:US
Mailing Address - Phone:706-951-8228
Mailing Address - Fax:
Practice Address - Street 1:106 DAVIS RD
Practice Address - Street 2:SUITE D
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1792
Practice Address - Country:US
Practice Address - Phone:706-651-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001764225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist