Individual
REBECCA SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1031 MORGANTOWN AVE, FAIRMONT, WV 26554-4355
(304) 363-0050
Mailing address
7112 CHADWOOD LN APT 2C, COLUMBUS, OH 43235-3905
(740) 312-4754
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004415
WV
225100000X
Physical Therapist
018457
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004415
WEST VIRGINIA BOARD OF PHYSICAL THERAPY
WV
01
—
018457
OHIO BOARD OF PHYSICAL THERAPY
OH
Enumeration date
06/21/2021
Last updated
10/11/2023
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