Provider Demographics
NPI:1205931813
Name:JOHNSON, REBECCA S (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W VAN BUREN ST
Mailing Address - Street 2:SUITE 100 BOX 419
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3523
Mailing Address - Country:US
Mailing Address - Phone:877-709-1090
Mailing Address - Fax:866-221-3400
Practice Address - Street 1:400 S COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4547
Practice Address - Country:US
Practice Address - Phone:877-709-1090
Practice Address - Fax:866-221-3400
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83535Medicare UPIN
IL209513001Medicare PIN