Provider Demographics
NPI:1033235098
Name:REBMAN, VICTOR L (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:REBMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1910 SAINT JOE CENTER RD
Mailing Address - Street 2:OFFICE #63
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5000
Mailing Address - Country:US
Mailing Address - Phone:260-471-9902
Mailing Address - Fax:260-471-9902
Practice Address - Street 1:1910 SAINT JOE CENTER RD
Practice Address - Street 2:OFFICE #63
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-471-9902
Practice Address - Fax:260-471-9902
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical