1801855705 NPI number — MRS. REBECCA LEE KLUG M.P.T.

Table of content: MRS. REBECCA LEE KLUG M.P.T. (NPI 1801855705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801855705 NPI number — MRS. REBECCA LEE KLUG M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUG
Provider First Name:
REBECCA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLUG
Provider Other First Name:
BECKY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1801855705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLEGATE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95703-0615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-878-6950
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 ELM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-4226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-889-2411
Provider Business Practice Location Address Fax Number:
530-889-2451
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  18256 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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