Provider Demographics
NPI:1083498695
Name:REBHOLZ, BRIANNA MEGAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:MEGAN
Last Name:REBHOLZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2316
Mailing Address - Country:US
Mailing Address - Phone:815-878-6721
Mailing Address - Fax:
Practice Address - Street 1:1424 MIDTOWN RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1271
Practice Address - Country:US
Practice Address - Phone:815-538-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005227208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation