Provider Demographics
NPI:1437280195
Name:RYAN, REBECCA H (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:H
Last Name:RYAN
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 1:936 CHESAPEAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1191
Mailing Address - Country:US
Mailing Address - Phone:847-223-8001
Mailing Address - Fax:847-986-3580
Practice Address - Street 1:10 N LAKE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3635
Practice Address - Country:US
Practice Address - Phone:847-223-8001
Practice Address - Fax:847-986-3580
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27220Medicare ID - Type UnspecifiedMEDICARE