Provider Demographics
NPI:1952467177
Name:REBOUND SPORTS AND ORTHOPEDIC PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:REBOUND SPORTS AND ORTHOPEDIC PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-673-1007
Mailing Address - Street 1:37 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1359
Mailing Address - Country:US
Mailing Address - Phone:315-673-1007
Mailing Address - Fax:315-673-2008
Practice Address - Street 1:37 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1359
Practice Address - Country:US
Practice Address - Phone:315-673-1007
Practice Address - Fax:315-673-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011106-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0461Medicare UPIN