Basic Information
| Provider Information | |||||||||
| NPI: | 1003475724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 WISTERIA DR STE A | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300782689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709820102 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4220 MUNDY MILL PL STE 2B | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305662573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784509933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2019 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT013957 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.