Healthcare Provider Details

I. General information

NPI: 1881879997
Provider Name (Legal Business Name): REBOUND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 BYERS CREEK RD
MOORESVILLE NC
28117-4376
US

IV. Provider business mailing address

156 BYERS CREEK RD
MOORESVILLE NC
28117-4376
US

V. Phone/Fax

Practice location:
  • Phone: 704-662-3210
  • Fax: 704-662-3605
Mailing address:
  • Phone: 704-662-3210
  • Fax: 704-662-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9540
License Number StateNC

VIII. Authorized Official

Name: REBECCA RICE
Title or Position: OWNER
Credential: P.T.
Phone: 704-662-3210