Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 16031 | MA |
N | 225100000X | Physical Therapist | 7112 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 7112 | CT |
N | 2251N0400X | Physical Therapist - Neurology | 7112 | CT |
N | 2251S0007X | Physical Therapist - Sports | 7112 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 7112 | CT |
N | 225400000X | Rehabilitation Practitioner | 7112 | CT |
NPI | 1275593741 |
---|---|
Provider Name | Rebecca J. Wing |
First Address | Palmer, MA 01069-1232 |
Second Address | Palmer, MA 01069-1232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 29/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061090356 | CIGNA ORTHONET GRP # (01) | CT |
061090356 | FEDERAL TAX ID# (01) | CT |
080007112CT01 | ANTHEM:REBECCAJ.ANDERSON (01) | CT |
119457 | AETNA GRP # (01) | CT |
764750001 | CIGNA GRP # (01) | CT |
ANC1648 | OXFORD GRP # (01) | CT |
C009365 | CHAMPUS GRP # (01) | CT |
CONN605700112 | PRIVATEHLTHCARESYS GRP# (01) | CT |
CT154333 | PREFEREEDHLTHNETWRK GRP# (01) | CT |
OV1296 | HEALTHNET GRP # (01) | CT |