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General NPI Number Information
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NPI Number | 1710099270
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Entity Type | Organization
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Legal Business Name | REBOUND PHYSICAL THERAPY CENTER PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/31/2011
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Provider Practice Location 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 | 815-877-6302
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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 | 815-877-6302
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Authorized Official
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Title or Position | PRESIDENT
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Name | K. MARK FISCHER
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Credential | D.O., L.P.T.
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | IL
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