Provider Demographics
NPI:1346733664
Name:BOLDEN, REBEKAH (DPT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:JAROSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 715868
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:804-915-1910
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:15300 E WEST RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3372
Practice Address - Country:US
Practice Address - Phone:804-320-4064
Practice Address - Fax:804-320-4052
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist