Basic Information
Provider Information
NPI: 1003002551
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BASSETT
FirstName: REBECCA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 885 MACBETH DR
Address2:  
City: MONROEVILLE
State: PA
PostalCode: 151463332
CountryCode: US
TelephoneNumber: 4128567071
FaxNumber: 4128567370
Practice Location
Address1: 885 MACBETH DR
Address2:  
City: MONROEVILLE
State: PA
PostalCode: 151463332
CountryCode: US
TelephoneNumber: 4128567071
FaxNumber: 4128567370
Other Information
ProviderEnumerationDate: 09/19/2007
LastUpdateDate: 10/16/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XTE007897PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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