Provider Demographics
NPI:1699235358
Name:CLOGSTON, REBEKAH JOY (DPT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JOY
Last Name:CLOGSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18151 68TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18151 68TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2835
Practice Address - Country:US
Practice Address - Phone:425-686-6760
Practice Address - Fax:425-686-6763
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019009236225100000X
WAPT61066078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist