Provider Demographics
NPI:1508993270
Name:REBELO, NEIL C (MS, LATC)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:C
Last Name:REBELO
Suffix:
Gender:M
Credentials:MS, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SALEM ST
Mailing Address - Street 2:UNIT 74
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 SALEM ST
Practice Address - Street 2:UNIT 74
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2064
Practice Address - Country:US
Practice Address - Phone:111-222-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer