Healthcare Provider Details

I. General information

NPI: 1144802844
Provider Name (Legal Business Name): REBOUND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W BROADWAY AVE
MINNEAPOLIS MN
55411-2612
US

IV. Provider business mailing address

710 W BROADWAY AVE
MINNEAPOLIS MN
55411-2612
US

V. Phone/Fax

Practice location:
  • Phone: 612-205-6640
  • Fax: 612-605-0046
Mailing address:
  • Phone: 612-205-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTY L BOTTS
Title or Position: DIRECTOR OF OPERATIONS
Credential: JD, M.ED.
Phone: 612-205-6640