Provider Demographics
NPI:1407888902
Name:REBOUND SPORTS AND ORTHOPEDIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:REBOUND SPORTS AND ORTHOPEDIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEENBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:907-341-5555
Mailing Address - Street 1:PO BOX 110171
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0171
Mailing Address - Country:US
Mailing Address - Phone:907-346-5171
Mailing Address - Fax:907-334-5705
Practice Address - Street 1:11260 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3038
Practice Address - Country:US
Practice Address - Phone:907-341-5555
Practice Address - Fax:907-341-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AK436918261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty