Provider Demographics
NPI:1427307354
Name:FILDES, REBECA (MPT)
Entity type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:FILDES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:
Other - Last Name:MANJARRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:6325 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1231
Mailing Address - Country:US
Mailing Address - Phone:630-649-0616
Mailing Address - Fax:
Practice Address - Street 1:6325 DEAN DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1231
Practice Address - Country:US
Practice Address - Phone:630-649-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0194012251X0800X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist