Provider Demographics
NPI:1013730092
Name:REBOOT PHYSICAL THERAPY
Entity type:Organization
Organization Name:REBOOT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:240-454-2527
Mailing Address - Street 1:9404 BELLE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-2800
Mailing Address - Country:US
Mailing Address - Phone:240-454-2527
Mailing Address - Fax:
Practice Address - Street 1:19847 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7204
Practice Address - Country:US
Practice Address - Phone:240-745-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE FITNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty