Provider Demographics
NPI:1013954247
Name:KLUSMAN'S REBOUND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KLUSMAN'S REBOUND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:513-794-9666
Mailing Address - Street 1:4934 WUNNENBERG WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4985
Mailing Address - Country:US
Mailing Address - Phone:513-794-9666
Mailing Address - Fax:513-794-0688
Practice Address - Street 1:10597 MONTGOMERY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4471
Practice Address - Country:US
Practice Address - Phone:513-794-9666
Practice Address - Fax:513-794-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF5825Medicare PIN
OH9358041Medicare PIN