Healthcare Provider Details

I. General information

NPI: 1457437170
Provider Name (Legal Business Name): REBECCA S MATTESON LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA S. EMERSON LPT

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 LEWIS AVE
ZION IL
60099-3099
US

IV. Provider business mailing address

PO BOX 72180
ROSELLE IL
60172-0180
US

V. Phone/Fax

Practice location:
  • Phone: 630-924-0156
  • Fax: 847-362-9486
Mailing address:
  • Phone: 630-924-0156
  • Fax: 630-924-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-013899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: