Provider Demographics
NPI:1659540888
Name:NILSON, REBEKAH LISETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LISETTE
Last Name:NILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:REBEKAH
Other - Middle Name:LISETTE
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:DEPARTMENT OF PAIN MANAGEMENT, IPMC
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-2888
Mailing Address - Fax:210-916-3050
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:DEPARTMENT OF PAIN MANAGEMENT, IPMC
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-2888
Practice Address - Fax:210-916-3050
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist