Healthcare Provider Details

I. General information

NPI: 1992753834
Provider Name (Legal Business Name): TSG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 JEFFERSONS GARDEN CT
EDMOND OK
73013-1410
US

IV. Provider business mailing address

4111 PAYSPHERE CIR
CHICAGO IL
60674-0041
US

V. Phone/Fax

Practice location:
  • Phone: 405-826-8918
  • Fax: 405-844-5535
Mailing address:
  • Phone: 405-917-0410
  • Fax: 405-917-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCHUSTER
Title or Position: CEO
Credential:
Phone: 405-917-0300