Healthcare Provider Details

I. General information

NPI: 1407032857
Provider Name (Legal Business Name): REHABILITATION MEDICINE SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL STE 115
BROKEN ARROW OK
74012-7844
US

IV. Provider business mailing address

PO BOX 2555
BROKEN ARROW OK
74013-2555
US

V. Phone/Fax

Practice location:
  • Phone: 918-451-5276
  • Fax:
Mailing address:
  • Phone: 918-451-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number19953
License Number StateOK

VIII. Authorized Official

Name: JODI LEIGH YELVERTON
Title or Position: PRESIDENT
Credential: M.D,
Phone: 918-451-5276