Healthcare Provider Details

I. General information

NPI: 1932101946
Provider Name (Legal Business Name): FIRSTCARE REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S HIGHWAY 183 SUITE 100
CLINTON OK
73601-9533
US

IV. Provider business mailing address

PO BOX 334
CLINTON OK
73601-0334
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-1682
  • Fax: 580-323-1711
Mailing address:
  • Phone: 580-323-1682
  • Fax: 580-323-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT2120
License Number StateOK

VIII. Authorized Official

Name: MR. LONNIE BRAND HARTSELL
Title or Position: VICE-PRESIDENT
Credential:
Phone: 580-323-1682