Provider Demographics
NPI:1063940591
Name:REBJAS LLC
Entity type:Organization
Organization Name:REBJAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-308-8941
Mailing Address - Street 1:33215 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3614
Mailing Address - Country:US
Mailing Address - Phone:407-252-2646
Mailing Address - Fax:
Practice Address - Street 1:32347 COUNTY ROAD 473
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8801
Practice Address - Country:US
Practice Address - Phone:352-308-8941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBJAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty