Provider Demographics
NPI:1073080230
Name:REBOUND ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:REBOUND ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BIALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-361-1000
Mailing Address - Street 1:584 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4578
Mailing Address - Country:US
Mailing Address - Phone:952-442-3233
Mailing Address - Fax:952-442-3233
Practice Address - Street 1:2805 CAMPUS DR STE 101
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2676
Practice Address - Country:US
Practice Address - Phone:612-361-1000
Practice Address - Fax:763-444-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier