Provider Demographics
NPI:1588912596
Name:CULVEY, REBECCA JO (PTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO
Last Name:CULVEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 E FLINT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3209
Mailing Address - Country:US
Mailing Address - Phone:248-693-0505
Mailing Address - Fax:248-693-6071
Practice Address - Street 1:585 E FLINT ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3209
Practice Address - Country:US
Practice Address - Phone:248-693-0505
Practice Address - Fax:248-693-6071
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant