Provider Demographics
NPI:1033461322
Name:REBOUND ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:REBOUND ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHAPPUIS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:612-756-2222
Mailing Address - Street 1:300 CATLIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2035
Mailing Address - Country:US
Mailing Address - Phone:763-684-1010
Mailing Address - Fax:763-684-2480
Practice Address - Street 1:300 CATLIN ST STE 104
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2035
Practice Address - Country:US
Practice Address - Phone:763-684-1010
Practice Address - Fax:763-684-2480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBOUND ORTHOTICS & PROSTHETICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5138920002OtherPTAN