Healthcare Provider Details

I. General information

NPI: 1619944378
Provider Name (Legal Business Name): REBOUND FITNESS AND REHABILITATION/REBOUND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD SUITE 1002
NORTHBROOK IL
60062-2727
US

IV. Provider business mailing address

666 DUNDEE RD SUITE 1002
NORTHBROOK IL
60062-2727
US

V. Phone/Fax

Practice location:
  • Phone: 847-714-7400
  • Fax: 224-723-5546
Mailing address:
  • Phone: 847-714-7400
  • Fax: 224-723-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number096000933
License Number StateIL

VIII. Authorized Official

Name: GREG CADICHON
Title or Position: ATHLETIC TRAINER/OWNER
Credential: ATC/L
Phone: 847-714-7400