Provider Demographics
NPI:1518412725
Name:ELSCHLAGER, REBECCA (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ELSCHLAGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813 N ASPEN WOOD DR APT 5104
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-8428
Mailing Address - Country:US
Mailing Address - Phone:217-219-0174
Mailing Address - Fax:
Practice Address - Street 1:1501 W BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61625-0001
Practice Address - Country:US
Practice Address - Phone:309-677-2978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960042692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer