Healthcare Provider Details

I. General information

NPI: 1477510907
Provider Name (Legal Business Name): REBOUND REHABILITATIVE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOUTHPARK BLVD. SUITE B201
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

105 SOUTHPARK BLVD. SUITE B201
ST. AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-1636
  • Fax: 904-824-7488
Mailing address:
  • Phone: 904-824-1636
  • Fax: 904-824-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEMANT D. PATEL
Title or Position: PRESIDENT
Credential: PT
Phone: 904-824-1636