Individual
REBECCA LYNNE BACZUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 N LAKEMONT AVE, WINTER PARK, FL 32792-3273
(407) 303-1332
(407) 303-0347
Mailing address
2388 BAYS EDGE AVE, VIRGINIA BEACH, VA 23451
(410) 991-4647
(443) 458-7224
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0101236813
VA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME153039
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113813700
—
FL
Enumeration date
12/14/2005
Last updated
02/29/2024
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