Provider Demographics
NPI:1003008582
Name:MENCIAS-REITZ, REBECCA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:MENCIAS-REITZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15941 LOREL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3832
Mailing Address - Country:US
Mailing Address - Phone:708-687-8258
Mailing Address - Fax:
Practice Address - Street 1:15941 LOREL AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3832
Practice Address - Country:US
Practice Address - Phone:708-687-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist