=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760256911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBOUND PAIN MANAGEMENT & REHABILITATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2023
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 W LOOP 281 STE 3
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75604-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-244-4080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 LAVENDER CIR
-----------------------------------------------------
City | HILTON HEAD ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29926-4420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-244-4080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MS. LAURA MARY LYONS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-244-4080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------