Individual provider Active NPI

Rebekah Vaca, DPT

  • Physical Therapist
  • San Dimas, CA
National Provider Identifier
1083369169
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT301712 Issued in CA
Practice address
630 W Arrow Hwy
San Dimas, CA 91773-2969
Phone
(909) 592-2778
Fax
(909) 592-2789
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT301712 CA Primary

Addresses

Primary practice location

630 W Arrow Hwy
San Dimas, CA 91773-2969

Mailing address

416 N 12TH St
Montebello, CA 90640-4106
Phone (323) 787-0325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT301712CAMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1083369169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 N 12TH ST",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404106",
            "telephone_number": "323-787-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W ARROW HWY",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732969",
            "telephone_number": "909-592-2778",
            "fax_number": "909-592-2789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACA",
        "first_name": "REBEKAH",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT301712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.