Individual
REBECCA L JACKSON WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
04502
OR
225100000X
Physical Therapist
PT00008445
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181491
—
OR
01
—
824151013
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/24/2007
Last updated
02/18/2014
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