Provider Demographics
NPI:1285322529
Name:REED, REBECCA SUSAN (LMT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUSAN
Last Name:REED
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 S SILVERTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8002
Mailing Address - Country:US
Mailing Address - Phone:479-295-9349
Mailing Address - Fax:
Practice Address - Street 1:2502 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3170
Practice Address - Country:US
Practice Address - Phone:479-636-1108
Practice Address - Fax:479-636-1148
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty