Provider Demographics
NPI:1710099270
Name:REBOUND PHYSICAL THERAPY CENTER PC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:K.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, LPT
Authorized Official - Phone:815-877-5932
Mailing Address - Street 1:3616 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-2159
Mailing Address - Country:US
Mailing Address - Phone:815-877-5932
Mailing Address - Fax:815-877-6302
Practice Address - Street 1:3616 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-2159
Practice Address - Country:US
Practice Address - Phone:815-877-5932
Practice Address - Fax:815-877-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210824Medicare ID - Type Unspecified