Individual
REBECCA KAY STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1210 DRY HOLLOW RD STE 1, THE DALLES, OR 97058-3167
(541) 296-3368
(541) 296-7866
Mailing address
1210 DRY HOLLOW RD STE 1, THE DALLES, OR 97058-3167
(541) 296-3368
(541) 296-7866
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1879
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093559
OMAP PROVIDER #
OR
01
—
212502263357
LIFEWISE PROVIDER #
OR
01
—
50324
CCHP PROVIDER NUMBER
OR
Enumeration date
10/13/2006
Last updated
07/08/2007
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