Provider Demographics
NPI:1477753291
Name:REBOUND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-585-2529
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2535
Practice Address - Street 1:61470 S HIGHWAY 97
Practice Address - Street 2:SUITE 4
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2187
Practice Address - Country:US
Practice Address - Phone:541-585-1022
Practice Address - Fax:541-585-1024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBOUND PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0965535-8225100000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR108471Medicare PIN