Provider Demographics
NPI:1659178556
Name:REBMANN, RYAN A (PTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:REBMANN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 FLORSHEIM DR STE 13
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3704
Mailing Address - Country:US
Mailing Address - Phone:847-680-1278
Mailing Address - Fax:847-680-2026
Practice Address - Street 1:736 FLORSHEIM DR STE 13
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3704
Practice Address - Country:US
Practice Address - Phone:847-680-1278
Practice Address - Fax:847-680-2026
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160006757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant