Provider Demographics
NPI:1821826165
Name:MENDOZA, REBEKAH LEANN (CMT)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEANN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:LEANN
Other - Last Name:KIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:25 W 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4559
Mailing Address - Country:US
Mailing Address - Phone:408-607-7430
Mailing Address - Fax:
Practice Address - Street 1:25 W 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4559
Practice Address - Country:US
Practice Address - Phone:408-607-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95625225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist