Healthcare Provider Details

I. General information

NPI: 1720040397
Provider Name (Legal Business Name): REBOUND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MOTHER JOSEPH PL SUITE G100
VANCOUVER WA
98664-3299
US

IV. Provider business mailing address

11610 NW 27TH COURT
VANCOUVER WA
98685
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-2048
  • Fax: 360-514-3155
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-707950
License Number StateOR

VIII. Authorized Official

Name: MR. BRADY W CORSE
Title or Position: ATHLETIC TRAINER
Credential: A.T.C
Phone: 360-514-2048