Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | IL |
NPI | 1003008582 |
---|---|
Provider Name | Mrs. Rebecca Mencias-Reitz |
First Address | Oak Forest, IL 60452-3832 |
Second Address | Oak Forest, IL 60452-3832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 17/08/2007 |