1093835233 NPI number — REBOUND PHYSICAL THERAPY, LLC

Table of content: MARTIN WILLIAM SCOBEY MD (NPI 1467478990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093835233 NPI number — REBOUND PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBOUND PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093835233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 SW INDUSTRIAL WAY
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-585-2529
Provider Business Mailing Address Fax Number:
541-585-2535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51600 HUNTINGTON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAPINE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97739-9626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-536-7443
Provider Business Practice Location Address Fax Number:
541-536-7805
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE COORDINATOR
Authorized Official Telephone Number:
541-585-2529

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0965535-8 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: 0965535-8 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 234859 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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