Basic Information
| Provider Information | |||||||||
| NPI: | 1710099270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REBOUND PHYSICAL 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: | 3616 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611032159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158775932 | ||||||||
| FaxNumber: | 8158776302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | FISCHER | ||||||||
| AuthorizedOfficialFirstName: | K. | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8158775932 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O., L.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | IL | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.