Provider Demographics
NPI:1407915754
Name:REBOUND OUTPATIENT PHYSICAL THERAPY, PA
Entity Type:Organization
Organization Name:REBOUND OUTPATIENT PHYSICAL THERAPY, PA
Other - Org Name:REBOUND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-842-2100
Mailing Address - Street 1:600 AIR PARK RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7022
Mailing Address - Country:US
Mailing Address - Phone:662-842-2100
Mailing Address - Fax:662-842-2105
Practice Address - Street 1:600 AIR PARK RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-7022
Practice Address - Country:US
Practice Address - Phone:662-842-2100
Practice Address - Fax:662-842-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3201261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy