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Individual
REBECCA SALLY
Active
Individual
REBECCA SALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA054990
PA
Other
Enumeration date
09/29/2011
Last updated
05/29/2020
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