Provider Demographics
NPI:1013214741
Name:RABANUS, BETHANY (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:RABANUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2866
Mailing Address - Country:US
Mailing Address - Phone:630-536-6376
Mailing Address - Fax:813-342-8683
Practice Address - Street 1:780 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2866
Practice Address - Country:US
Practice Address - Phone:630-536-6376
Practice Address - Fax:813-342-8683
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011683261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy