Provider Demographics
NPI:1750404489
Name:ELLER, REBECCA LYN MAHER (MSPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYN MAHER
Last Name:ELLER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SPOHN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3428
Mailing Address - Country:US
Mailing Address - Phone:608-345-5107
Mailing Address - Fax:
Practice Address - Street 1:425 6TH ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1202
Practice Address - Country:US
Practice Address - Phone:608-963-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4077-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40408100Medicaid