Healthcare Provider Details

I. General information

NPI: 1982848339
Provider Name (Legal Business Name): REBOUND PHYSICAL THERAPY II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SW CENTURY DR SUITE 100
BEND OR
97702-1657
US

IV. Provider business mailing address

805 SW INDUSTRIAL WAY SUITE 3
BEND OR
97702-1093
US

V. Phone/Fax

Practice location:
  • Phone: 541-322-9045
  • Fax: 541-322-9044
Mailing address:
  • Phone: 541-585-2529
  • Fax: 541-585-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RICHARDSON
Title or Position: COMPLIANCE COORDINATOR
Credential:
Phone: 541-585-2529