Healthcare Provider Details

I. General information

NPI: 1841021367
Provider Name (Legal Business Name): BOUNCE BACK REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 W SAMPLE RD
CORAL SPRINGS FL
33065-4713
US

IV. Provider business mailing address

8035 W SAMPLE RD
CORAL SPRINGS FL
33065-4713
US

V. Phone/Fax

Practice location:
  • Phone: 952-388-9094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM HILLYARD
Title or Position: OWNER
Credential:
Phone: 952-388-9094