Provider Demographics
NPI:1538445838
Name:OSTERGAARD, REBEKKA VAIL (PT)
Entity type:Individual
Prefix:MRS
First Name:REBEKKA
Middle Name:VAIL
Last Name:OSTERGAARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3356
Mailing Address - Country:US
Mailing Address - Phone:847-381-6757
Mailing Address - Fax:
Practice Address - Street 1:1845 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6712
Practice Address - Country:US
Practice Address - Phone:847-414-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.012950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist