Provider Demographics
NPI:1881879997
Name:REBOUND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:REBOUND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:704-662-3210
Mailing Address - Street 1:156 BYERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4376
Mailing Address - Country:US
Mailing Address - Phone:704-662-3210
Mailing Address - Fax:704-662-3605
Practice Address - Street 1:156 BYERS CREEK RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4376
Practice Address - Country:US
Practice Address - Phone:704-662-3210
Practice Address - Fax:704-662-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079YYOtherINDIVIDUAL BCBS NUMBER
NC2504054AOtherMEDICARE GROUP