Provider Demographics
NPI:1952803728
Name:REBMAN, KEVIN (CMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:REBMAN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 96TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4458
Mailing Address - Country:US
Mailing Address - Phone:612-940-0971
Mailing Address - Fax:
Practice Address - Street 1:5250 W 74TH ST STE 8
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2229
Practice Address - Country:US
Practice Address - Phone:763-270-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN965025146N00000X
172M00000X
MNNA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No172M00000XOther Service ProvidersMechanotherapist