Provider Demographics
NPI:1871704320
Name:TOKARCZYK, REBECCA EG (PT, MED)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:EG
Last Name:TOKARCZYK
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 E VILLA DR STE 5
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4647
Mailing Address - Country:US
Mailing Address - Phone:928-496-0228
Mailing Address - Fax:
Practice Address - Street 1:1770 E VILLA DR STE 5
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4647
Practice Address - Country:US
Practice Address - Phone:928-496-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6207225100000X, 2251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ469548682OtherVA PRESCOTT
AZ001795933OtherUSAA
AZ03-3751-463OtherSTATE FARM