Provider Demographics
NPI:1316177686
Name:SIPE, REBECA Y (RMT)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:Y
Last Name:SIPE
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VERMEER DR.
Mailing Address - Street 2:SUITE 2 BOX 173
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852
Mailing Address - Country:US
Mailing Address - Phone:707-837-3718
Mailing Address - Fax:
Practice Address - Street 1:582 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8812
Practice Address - Country:US
Practice Address - Phone:707-837-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist