Provider Demographics
NPI:1699405282
Name:DELVENTHAL, REBEKAH ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELIZABETH
Last Name:DELVENTHAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26906 STEAMBOAT HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-8460
Mailing Address - Country:US
Mailing Address - Phone:608-604-1427
Mailing Address - Fax:
Practice Address - Street 1:26906 STEAMBOAT HOLLOW LN
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-8460
Practice Address - Country:US
Practice Address - Phone:608-604-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3200-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty