Provider Demographics
NPI:1134383326
Name:MAUPIN, REBECCA JANE (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:HANNERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3495 W EL PASO DR
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-7753
Mailing Address - Country:US
Mailing Address - Phone:815-592-8209
Mailing Address - Fax:
Practice Address - Street 1:517 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-1258
Practice Address - Country:US
Practice Address - Phone:815-802-7503
Practice Address - Fax:815-802-7514
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
ILP00932901OtherMEDICARE RAILROAD
ILK53303Medicare PIN
IL209812010Medicare PIN
IL568150Medicare PIN
IL1619980OtherBCBS OF IL
IL568080Medicare PIN
ILK53304Medicare PIN
ILK53305Medicare PIN