Provider Demographics
NPI:1225698541
Name:BOUNCE BACK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BOUNCE BACK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-743-0396
Mailing Address - Street 1:757 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1803
Mailing Address - Country:US
Mailing Address - Phone:317-967-8787
Mailing Address - Fax:
Practice Address - Street 1:757 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1803
Practice Address - Country:US
Practice Address - Phone:317-967-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy