Provider Demographics
NPI:1629890736
Name:REBISZ, MARYAM ARNERIS (PT)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:ARNERIS
Last Name:REBISZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:ARNERIS
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:268 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2117
Mailing Address - Country:US
Mailing Address - Phone:908-217-0370
Mailing Address - Fax:
Practice Address - Street 1:1423 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3138
Practice Address - Country:US
Practice Address - Phone:253-881-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01844500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist