Provider Demographics
NPI:1588790042
Name:MATTOCKS, REBECCA MURRELL (PT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MURRELL
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:MURRELL
Other - Last Name:MATTOCKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2712 KIVETT DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-9744
Mailing Address - Country:US
Mailing Address - Phone:336-852-4865
Mailing Address - Fax:336-852-5413
Practice Address - Street 1:2712 KIVETT DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-9744
Practice Address - Country:US
Practice Address - Phone:336-852-4865
Practice Address - Fax:336-852-5413
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07781OtherBCBS
NC7210374Medicaid