Provider Demographics
NPI:1255377263
Name:ANN L. RAEBEL, PT
Entity type:Organization
Organization Name:ANN L. RAEBEL, PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-631-7262
Mailing Address - Street 1:PO BOX 2234
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-2234
Mailing Address - Country:US
Mailing Address - Phone:479-631-7262
Mailing Address - Fax:479-631-6366
Practice Address - Street 1:1420 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-5334
Practice Address - Country:US
Practice Address - Phone:479-631-7262
Practice Address - Fax:479-631-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1923208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T977OtherBLUE CROSS