Provider Demographics
NPI:1346561487
Name:THE REBOUND GROUP, LLC
Entity type:Organization
Organization Name:THE REBOUND GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRETTITORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:201-345-7044
Mailing Address - Street 1:233 ROCK RD
Mailing Address - Street 2:# 236
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1708
Mailing Address - Country:US
Mailing Address - Phone:201-345-7044
Mailing Address - Fax:201-345-7062
Practice Address - Street 1:233 ROCK RD
Practice Address - Street 2:# 236
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1708
Practice Address - Country:US
Practice Address - Phone:201-345-7044
Practice Address - Fax:201-345-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00989800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083663926OtherINDIVIDUAL NPI