Provider Demographics
NPI:1083209290
Name:REBOUND BRACING AND ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:REBOUND BRACING AND ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOCKRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-806-3002
Mailing Address - Street 1:330 N MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4459
Mailing Address - Country:US
Mailing Address - Phone:937-806-3002
Mailing Address - Fax:937-806-3494
Practice Address - Street 1:330 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4459
Practice Address - Country:US
Practice Address - Phone:937-806-3002
Practice Address - Fax:937-806-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies