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Organization
REBOUND PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Active
Organization
REBOUND PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK DALTON PT, DPT (OWNER)
(304) 310-4721
Entity
Organization
Contact information
Practice address
560 MAIN STREET, CHAPMANVILLE, WV 25508
(304) 310-4721
(304) 310-4723
Mailing address
PO BOX 945, CHAPMANVILLE, WV 25508-0945
(304) 310-4721
(304) 310-4723
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
PT002703
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2697553
BCBS
WV
05
—
3810023132
—
WV
Enumeration date
03/29/2012
Last updated
06/26/2012
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