Provider Demographics
NPI:1699759084
Name:SMITH, REBECCA C (DPT)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:C
Last Name:SMITH
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:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0030
Mailing Address - Country:US
Mailing Address - Phone:781-344-3535
Mailing Address - Fax:508-535-0192
Practice Address - Street 1:15 ROCHE BROS WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356
Practice Address - Country:US
Practice Address - Phone:781-344-3535
Practice Address - Fax:508-535-0192
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0031029OtherNEIGHBORHOOD HEALTH
MA7947546OtherAETNA/USHC
MA0323314Medicaid
MA468869OtherTUFTS
MA626575OtherHPHC
MAY69253Medicare ID - Type UnspecifiedPT PROVIDER