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General NPI Number Information
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NPI Number | 1083209290
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Entity Type | Organization
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Legal Business Name | REBOUND BRACING AND ORTHOPEDICS LLC
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Dates
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Enumeration Date | 03/09/2021
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 330 N MAIN ST STE 103
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City | CENTERVILLE
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State | OH
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Zip | 45459-4459
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Country | US
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Telephone | 937-806-3002
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Fax | 937-806-3494
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Provider Business Mailing Address
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Address Line | 330 N MAIN ST STE 103
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City | CENTERVILLE
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State | OH
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Zip | 45459-4459
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Country | US
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Telephone | 937-806-3002
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Fax | 937-806-3494
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID MICHAEL BOCKRATH
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Credential |
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Telephone | 937-806-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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