Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 039699-1 | NY |
N | 2081S0010X | Sports Medicine | 039699-1 | NY |
N | 213ES0000X | Sports Medicine | 039699-1 | NY |
N | 225100000X | Physical Therapist |
NPI | 1093353815 |
---|---|
Provider Name | Rebecca Menard |
First Address | Sayre, PA 18840-1625 |
Second Address | Horseheads, NY 14845-1403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2019 |
Last Update Date | 24/03/2021 |