Provider Demographics
NPI:1699540963
Name:WANG, REBECCA E (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:WANG
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 1:3632 BEECHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514
Mailing Address - Country:US
Mailing Address - Phone:859-797-5485
Mailing Address - Fax:
Practice Address - Street 1:350 RADIO PARK DRIVE
Practice Address - Street 2:STE. 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2998
Practice Address - Country:US
Practice Address - Phone:859-625-5986
Practice Address - Fax:859-625-5987
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty