Provider Demographics
NPI:1962528125
Name:ANDERS, REBECCA LYN (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYN
Last Name:ANDERS
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 1:307 CIRCLE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3211
Mailing Address - Country:US
Mailing Address - Phone:304-575-5603
Mailing Address - Fax:
Practice Address - Street 1:331 HOLT LN
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1774
Practice Address - Country:US
Practice Address - Phone:304-645-4830
Practice Address - Fax:304-645-4815
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2280225100000X
VA2305204068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist