Provider Demographics
NPI:1710955513
Name:EISMAN, REBECCA L (PT, CHT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:EISMAN
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003B OAK RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1826
Mailing Address - Country:US
Mailing Address - Phone:770-979-3272
Mailing Address - Fax:770-979-4442
Practice Address - Street 1:1003B OAK RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1826
Practice Address - Country:US
Practice Address - Phone:770-979-3272
Practice Address - Fax:770-979-4442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2388225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS84573Medicare UPIN
GA65BBBZQMedicare ID - Type Unspecified