Provider Demographics
NPI:1124321823
Name:THOMAS, REBECCA JEAN (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 LAUREATE DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2680
Mailing Address - Country:US
Mailing Address - Phone:262-408-8923
Mailing Address - Fax:
Practice Address - Street 1:203 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3435
Practice Address - Country:US
Practice Address - Phone:262-408-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10388-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist