Provider Demographics
NPI:1386137636
Name:THOMAS, REBECCA FITZWATER
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:FITZWATER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15368 BENNS CHURCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-2107
Mailing Address - Country:US
Mailing Address - Phone:757-372-3920
Mailing Address - Fax:
Practice Address - Street 1:15368 BENNS CHURCH BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-2107
Practice Address - Country:US
Practice Address - Phone:757-372-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)