Provider Demographics
NPI:1699985879
Name:TERRY, REBECCA FLEISHER (PT, OCS)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:FLEISHER
Last Name:TERRY
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:MRS
Other - First Name:BETSY
Other - Middle Name:FLEISHER
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:19714 VINTAGE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3549
Mailing Address - Country:US
Mailing Address - Phone:818-885-1734
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4749
Practice Address - Country:US
Practice Address - Phone:310-474-5150
Practice Address - Fax:310-474-4924
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT93062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic