Basic Information
| Provider Information | |||||||||
| NPI: | 1508254392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERST | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | ATC,LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2570 W 750 S | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467409728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2608499000 | ||||||||
| FaxNumber: | 2605892070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 MERCER AVE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467332303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607242145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2014 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 36000199A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.