Provider Demographics
NPI:1497700512
Name:REBOUND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY LLC
Other - Org Name:REBOUND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:615-373-8100
Mailing Address - Street 1:209 WARD CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7579
Mailing Address - Country:US
Mailing Address - Phone:615-373-8100
Mailing Address - Fax:615-309-9306
Practice Address - Street 1:209 WARD CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7579
Practice Address - Country:US
Practice Address - Phone:615-373-8100
Practice Address - Fax:615-309-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731686Medicare ID - Type UnspecifiedGROUP PRICING NUMBER