Organization
REBOUND PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL K LANGLEY RPT, OCS (OWNER)
(208) 939-3332
Entity
Organization
Contact information
Practice address
1175 E PARKCENTER BLVD, STE 104, BOISE, ID 83706-6751
(208) 344-2525
(208) 344-3056
Mailing address
1175 E PARKCENTER BLVD, STE 104, BOISE, ID 83706-6751
(208) 344-2525
(208) 344-3056
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010151218
BLUE SHIELD
—
05
—
807277100
—
ID
01
—
T9401
BLUE CROSS
ID
Enumeration date
10/06/2006
Last updated
05/06/2010
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