Provider Demographics
NPI:1225152010
Name:REBOUND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUEHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:401-739-1223
Mailing Address - Street 1:25 CORONADO RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1404
Mailing Address - Country:US
Mailing Address - Phone:401-739-1223
Mailing Address - Fax:401-739-2002
Practice Address - Street 1:25 CORONADO RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1404
Practice Address - Country:US
Practice Address - Phone:401-739-1223
Practice Address - Fax:401-739-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI659004162Medicare ID - Type UnspecifiedPHYSICAL THERAPY