Provider Demographics
NPI:1619944378
Name:REBOUND FITNESS AND REHABILITATION/REBOUND SPORTS MEDICINE
Entity Type:Organization
Organization Name:REBOUND FITNESS AND REHABILITATION/REBOUND SPORTS MEDICINE
Other - Org Name:REBOUND FITNESS, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ATHLETIC TRAINER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CADICHON
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/L
Authorized Official - Phone:847-714-7400
Mailing Address - Street 1:666 DUNDEE RD
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2727
Mailing Address - Country:US
Mailing Address - Phone:847-714-7400
Mailing Address - Fax:224-723-5546
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 1002
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-714-7400
Practice Address - Fax:224-723-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096000933261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center