Provider Demographics
NPI:1306144035
Name:KEACH, REBECCA KREDAN (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KREDAN
Last Name:KEACH
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 1:1675 RIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5315
Mailing Address - Country:US
Mailing Address - Phone:850-656-4800
Mailing Address - Fax:850-656-4872
Practice Address - Street 1:1675 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5315
Practice Address - Country:US
Practice Address - Phone:850-656-4800
Practice Address - Fax:850-656-4872
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7346225100000X
FLPT 26054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist