Provider Demographics
NPI:1972340610
Name:DURANT, REBECCA E
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:DURANT
Suffix:
Gender:F
Credentials:
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 495
Mailing Address - Street 2:
Mailing Address - City:KALEVA
Mailing Address - State:MI
Mailing Address - Zip Code:49645-0495
Mailing Address - Country:US
Mailing Address - Phone:231-392-1610
Mailing Address - Fax:
Practice Address - Street 1:14659 PANU ST
Practice Address - Street 2:
Practice Address - City:KALEVA
Practice Address - State:MI
Practice Address - Zip Code:49645-9305
Practice Address - Country:US
Practice Address - Phone:231-392-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist