Provider Demographics
NPI:1376534636
Name:ROUNDS, JEFFREY BRUCE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRUCE
Last Name:ROUNDS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S WOODALE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2551
Mailing Address - Country:US
Mailing Address - Phone:217-428-7167
Mailing Address - Fax:
Practice Address - Street 1:102 W KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4300
Practice Address - Country:US
Practice Address - Phone:217-876-6820
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer