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General NPI Number Information
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NPI Number | 1225698541
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Entity Type | Organization
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Legal Business Name | BOUNCE BACK PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 757 E 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1803
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Country | US
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Telephone | 317-967-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 757 E 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1803
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Country | US
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Telephone | 317-967-8787
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LYNN JUSTUSSON
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Credential |
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Telephone | 800-743-0396
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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 |
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