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General NPI Number Information
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NPI Number | 1053431031
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Entity Type | Organization
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Legal Business Name | REBOUND THERAPY CETER
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1985 DEKALB AVE STE 300
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City | SYCAMORE
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State | IL
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Zip | 60178-3107
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Country | US
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Telephone | 815-754-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 3616 N MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61103-2159
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Country | US
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Telephone | 815-877-5932
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRIIA L WOOWARD
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Credential |
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Telephone | 815-877-5932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IL
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