1104328269 NPI number — REBOUND REHABILITATIVE SERVICES INC

Table of content: (NPI 1104328269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104328269 NPI number — REBOUND REHABILITATIVE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBOUND REHABILITATIVE SERVICES INC
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:
1104328269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 SOUTHPARK BLVD STE B201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-5159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-824-1636
Provider Business Mailing Address Fax Number:
904-824-7488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 PARK AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-824-1636
Provider Business Practice Location Address Fax Number:
904-824-7488
Provider Enumeration Date:
03/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
HEMANT
Authorized Official Middle Name:
DASHARATHLAL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-824-1636

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Q81 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 106714 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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