Provider Demographics
NPI:1023310711
Name:REBOUND FITNESS INC
Entity type:Organization
Organization Name:REBOUND FITNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CADICHON
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:630-376-6096
Mailing Address - Street 1:666 DUNDEE RD STE 1002
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2735
Mailing Address - Country:US
Mailing Address - Phone:847-714-7400
Mailing Address - Fax:
Practice Address - Street 1:246 E. JANATA BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-376-6096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018154261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy