1568241636 NPI number — REBECCA RUTH-LABASTIDA GILES PT

Table of content: REBECCA RUTH-LABASTIDA GILES PT (NPI 1568241636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568241636 NPI number — REBECCA RUTH-LABASTIDA GILES PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILES
Provider First Name:
REBECCA
Provider Middle Name:
RUTH-LABASTIDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568241636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49650 CHERRY HILL RD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48187-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
344-953-7257
Provider Business Mailing Address Fax Number:
734-495-3734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49650 CHERRY HILL RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48187-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
344-953-7257
Provider Business Practice Location Address Fax Number:
734-495-3734
Provider Enumeration Date:
09/27/2023

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:  5501016839 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com