Provider Demographics
NPI:1760825012
Name:BOUNCE BACK REHAB, PLC
Entity type:Organization
Organization Name:BOUNCE BACK REHAB, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-272-1039
Mailing Address - Street 1:12899 E 76TH ST N
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4021
Mailing Address - Country:US
Mailing Address - Phone:918-272-1039
Mailing Address - Fax:918-272-7159
Practice Address - Street 1:12899 E 76TH ST N
Practice Address - Street 2:SUITE 116
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4021
Practice Address - Country:US
Practice Address - Phone:918-272-1039
Practice Address - Fax:918-272-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty