Provider Demographics
NPI:1700355955
Name:HOLLENBERG, REBEKAH L (LMT, CIMI)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:L
Last Name:HOLLENBERG
Suffix:
Gender:F
Credentials:LMT, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1251
Mailing Address - Country:US
Mailing Address - Phone:480-678-7179
Mailing Address - Fax:
Practice Address - Street 1:108 E CENTER ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1251
Practice Address - Country:US
Practice Address - Phone:480-678-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.017323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist