MEDICARE: REBOUND FITNESS AND REHABILITATION/REBOUND SPORTS MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	096000933	IL

General Provider Information

NPI Number	:	1619944378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBOUND FITNESS AND REHABILITATION/REBOUND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	666 DUNDEE RD
Second Line	:	SUITE 1002
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2727
Country	:	US
Telephone Number	:	847-714-7400
Fax Number	:	224-723-5546

Provider Business Practice Location Address
First Line	:	666 DUNDEE RD
Second Line	:	SUITE 1002
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2727
Country	:	US
Telephone Number	:	847-714-7400
Fax Number	:	224-723-5546

Authorized Official
Title or Position	:	ATHLETIC TRAINER/OWNER
Name	:	GREG CADICHON
Credential	:	ATC/L
Telephone Number	:	847-714-7400

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	12/08/2015

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