Basic Information
| Provider Information | |||||||||
| NPI: | 1447464003 | ||||||||
| 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: | 1985 DEKALB AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SYCAMORE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601783107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158775932 | ||||||||
| FaxNumber: | 8158776302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FISCHER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8158775932 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.