Provider Demographics
NPI:1407864085
Name:REBMAN, LESTER WALTER (PT)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:WALTER
Last Name:REBMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4733
Mailing Address - Country:US
Mailing Address - Phone:815-398-7193
Mailing Address - Fax:815-227-1744
Practice Address - Street 1:2662 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6806
Practice Address - Country:US
Practice Address - Phone:815-227-1700
Practice Address - Fax:815-227-1744
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
L85713Medicare ID - Type Unspecified
P30993Medicare UPIN