Provider Demographics
NPI:1912094707
Name:REBOUND PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:REBOUND PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRYCHASZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-471-7570
Mailing Address - Street 1:PO BOX 770980
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-0043
Mailing Address - Country:US
Mailing Address - Phone:440-471-7570
Mailing Address - Fax:440-471-7644
Practice Address - Street 1:11716 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-712-7816
Practice Address - Fax:216-712-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8441261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2721326Medicaid
OH2721326Medicaid
OH9364501Medicare PIN