Healthcare Provider Details

I. General information

NPI: 1285602466
Provider Name (Legal Business Name): REBOUND PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 QUEMAZON
LOS ALAMOS NM
87544-1889
US

IV. Provider business mailing address

4717 QUEMAZON
LOS ALAMOS NM
87544-1889
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-2225
  • Fax:
Mailing address:
  • Phone: 505-662-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3141
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1451
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1558
License Number StateNM

VIII. Authorized Official

Name: MS. CINDY LAWTON
Title or Position: DIRECTOR
Credential:
Phone: 505-662-2225