Provider Demographics
NPI:1619328002
Name:BEGALLE, REBECCA L (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:BEGALLE
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 1:251A MCCORMICK HL
Mailing Address - Street 2:CAMPUS BOX 5120
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61790-5120
Mailing Address - Country:US
Mailing Address - Phone:309-438-2605
Mailing Address - Fax:309-438-5559
Practice Address - Street 1:251A MCCORMICK HL
Practice Address - Street 2:CAMPUS BOX 5120
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61790-5120
Practice Address - Country:US
Practice Address - Phone:309-438-2605
Practice Address - Fax:309-438-5559
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0039862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer