Provider Demographics
NPI:1083160683
Name:DISHMAN, REBECCA ANN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:FARRINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:425 SANDCREEK DR N
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1590
Mailing Address - Country:US
Mailing Address - Phone:219-926-9779
Mailing Address - Fax:219-926-9889
Practice Address - Street 1:425 SANDCREEK DR N
Practice Address - Street 2:SUITE C
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1590
Practice Address - Country:US
Practice Address - Phone:219-926-9779
Practice Address - Fax:219-926-9889
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21605824173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist