Provider Demographics
NPI:1790929149
Name:REBOUND PHYSICAL THERAPY II, LLC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY II, LLC
Other - Org Name:REBOUND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MED BILLING & INSURANCE MANAGER
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:541-585-2536
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1855
Practice Address - Country:US
Practice Address - Phone:541-416-7476
Practice Address - Fax:541-416-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR523039000OtherREGENCE BLUE CROSS
OR500609593Medicaid
OR523039000OtherREGENCE BLUE CROSS
OR6221370001Medicare NSC