Provider Demographics
NPI:1689621419
Name:REBOUND PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:RATTRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:612-436-0777
Mailing Address - Street 1:2700 EAST LAKE STREET
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2690
Mailing Address - Country:US
Mailing Address - Phone:612-436-0777
Mailing Address - Fax:612-436-0779
Practice Address - Street 1:2700 EAST LAKE STREET
Practice Address - Street 2:SUITE 2450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2690
Practice Address - Country:US
Practice Address - Phone:612-436-0777
Practice Address - Fax:612-436-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN302345100Medicaid
MN302345100Medicaid