Provider Demographics
NPI:1417466202
Name:PROFESSIONAL REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL REHABILITATION SERVICES, INC.
Other - Org Name:REBOUND HOME AND COMMUNITY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-202-4840
Mailing Address - Street 1:4234 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8384
Mailing Address - Country:US
Mailing Address - Phone:616-464-1117
Mailing Address - Fax:
Practice Address - Street 1:2211 E BELTLINE AVE NE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9802
Practice Address - Country:US
Practice Address - Phone:616-202-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty