Provider Demographics
NPI:1417570326
Name:REBOUND REHABILITATIVE SERVICES INC
Entity Type:Organization
Organization Name:REBOUND REHABILITATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:DASHARATHLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-824-1636
Mailing Address - Street 1:105 SOUTHPARK BLVD STE B201
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5159
Mailing Address - Country:US
Mailing Address - Phone:904-824-1636
Mailing Address - Fax:904-824-7488
Practice Address - Street 1:5913 NORMANDY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6269
Practice Address - Country:US
Practice Address - Phone:904-549-9500
Practice Address - Fax:904-549-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106714OtherPTAN
FLQ81OtherBCBS