Provider Demographics
NPI:1699430470
Name:GRATZ, REBECCA LANE (CPSS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LANE
Last Name:GRATZ
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 CHEROKEE RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1278
Mailing Address - Country:US
Mailing Address - Phone:502-224-1815
Mailing Address - Fax:
Practice Address - Street 1:501 BAXTER AVE STE 125
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1103
Practice Address - Country:US
Practice Address - Phone:502-233-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist