Provider Demographics
NPI:1861789703
Name:PHILLIPS, REBEKA M (LMT)
Entity type:Individual
Prefix:
First Name:REBEKA
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:REBEKA
Other - Middle Name:M
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1104 S WALTON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6120
Mailing Address - Country:US
Mailing Address - Phone:479-883-3198
Mailing Address - Fax:
Practice Address - Street 1:105 WALL ST
Practice Address - Street 2:1ST FLOOR - CAROL WEDDLE'S OFFICE
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4433
Practice Address - Country:US
Practice Address - Phone:479-883-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist