MEDICARE: REBOUND REHABILITATIVE SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106714	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Q81	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1871153213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBOUND REHABILITATIVE SERVICES INC

Provider Business Mailing Address
First Line	:	105 SOUTHPARK BLVD STE B201
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5159
Country	:	US
Telephone Number	:	904-824-1636
Fax Number	:	904-824-7488

Provider Business Practice Location Address
First Line	:	8081 PHILIPS HWY STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7443
Country	:	US
Telephone Number	:	904-872-3100
Fax Number	:	904-872-3106

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HEMANT DASHARATHLAL PATEL
Credential	:	PT
Telephone Number	:	904-824-1636

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	05/26/2020

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Directions to “REBOUND REHABILITATIVE SERVICES INC ” Practice Location

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