Provider Demographics
NPI:1427386770
Name:ALDRIDGE, REBEKAH RUTH (PA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RUTH
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:822 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-2500
Mailing Address - Country:US
Mailing Address - Phone:435-884-3578
Mailing Address - Fax:435-884-3582
Practice Address - Street 1:822 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-2500
Practice Address - Country:US
Practice Address - Phone:435-884-3578
Practice Address - Fax:435-884-3582
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT74919181206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000068337Medicare PIN