Provider Demographics
NPI:1124334024
Name:HEALY, REBECCA (LMT,CYT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:HEALY
Suffix:
Gender:F
Credentials:LMT,CYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2358
Mailing Address - Country:US
Mailing Address - Phone:802-379-8673
Mailing Address - Fax:
Practice Address - Street 1:521 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2358
Practice Address - Country:US
Practice Address - Phone:802-379-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist