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General NPI Number Information
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NPI Number | 1134186869
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Entity Type | Individual
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Provider Name | REBECCA LYNN ANDERSON PTA, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1816 170TH ST
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City | HAZEL CREST
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State | IL
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Zip | 60429-1451
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Country | US
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Telephone | 708-335-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 16025 APPLEWOOD LN APT 202
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City | ORLAND HILLS
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State | IL
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Zip | 60487-3183
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Country | US
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Telephone | 217-620-5887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 096000570
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1600005684
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License Number State | IL
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