Healthcare Provider Details

I. General information

NPI: 1700303971
Provider Name (Legal Business Name): ELENA REBHOLZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15820 ADDISON RD
ADDISON TX
75001-3549
US

IV. Provider business mailing address

92 WESTCHESTER AVE
ROCHESTER NY
14609-4231
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-2999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042047-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0016256
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: