Provider Demographics
NPI:1427867449
Name:BILLERBECK, MARY THERESE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:BILLERBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4262
Mailing Address - Country:US
Mailing Address - Phone:262-497-9147
Mailing Address - Fax:
Practice Address - Street 1:414 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-4262
Practice Address - Country:US
Practice Address - Phone:262-497-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2882-242081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine