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General NPI Number Information
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NPI Number | 1558419713
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Entity Type | Individual
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Provider Name | SARA R EBEL A.T.,C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 05/12/2013
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Provider Practice Location Address
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Address Line | 2361 ELM ST
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City | PLOVER
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State | WI
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Zip | 54467-2164
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Country | US
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Telephone | 715-252-8683
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Fax |
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Provider Business Mailing Address
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Address Line | 2361 ELM ST
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City | PLOVER
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State | WI
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Zip | 54467-2164
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Country | US
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Telephone | 715-252-8683
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 799-039
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License Number State | WI
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