Provider Demographics
NPI:1104328269
Name:REBOUND REHABILITATIVE SERVICES INC
Entity type:Organization
Organization Name:REBOUND REHABILITATIVE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:DASHARATHLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-824-1636
Mailing Address - Street 1:105 SOUTHPARK BLVD STE B201
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5159
Mailing Address - Country:US
Mailing Address - Phone:904-824-1636
Mailing Address - Fax:904-824-7488
Practice Address - Street 1:904 PARK AVE STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4120
Practice Address - Country:US
Practice Address - Phone:904-824-1636
Practice Address - Fax:904-824-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ81OtherBCBS
106714OtherMEDICARE PTAN