Basic Information
| Provider Information | |||||||||
| NPI: | 1073751921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REBOUND THERAPY CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3616 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611032159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158775932 | ||||||||
| FaxNumber: | 8158776302 | ||||||||
| Practice Location | |||||||||
| Address1: | 4675 BLUESTEM RD | ||||||||
| Address2: | |||||||||
| City: | ROSCOE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610737788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158775932 | ||||||||
| FaxNumber: | 8158776302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | WOODWARD | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8158775932 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.