Provider Demographics
NPI:1487739173
Name:REBOUND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:REBOUND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:KAFATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-445-9799
Mailing Address - Street 1:1432 TOWNE LAKE PKWY
Mailing Address - Street 2:120
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8263
Mailing Address - Country:US
Mailing Address - Phone:678-445-9799
Mailing Address - Fax:678-445-2688
Practice Address - Street 1:1432 TOWNE LAKE PKWY
Practice Address - Street 2:120
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8263
Practice Address - Country:US
Practice Address - Phone:678-445-9799
Practice Address - Fax:678-445-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7913Medicare PIN