Provider Demographics
NPI:1154703460
Name:SEGRAVES, REBECA LUISA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:REBECA
Middle Name:LUISA
Last Name:SEGRAVES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6364 MARILEE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-8356
Mailing Address - Country:US
Mailing Address - Phone:719-270-0155
Mailing Address - Fax:719-349-5267
Practice Address - Street 1:6364 MARILEE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-8356
Practice Address - Country:US
Practice Address - Phone:719-270-0155
Practice Address - Fax:719-349-5267
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT-2024-0030225100000X
TX1325234225100000X
CO0017364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist