Healthcare Provider Details

I. General information

NPI: 1639617996
Provider Name (Legal Business Name): ADAPT PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19205 GREENERY LN
EDMOND OK
73012-9644
US

IV. Provider business mailing address

19205 GREENERY LN
EDMOND OK
73012-9644
US

V. Phone/Fax

Practice location:
  • Phone: 405-473-8176
  • Fax:
Mailing address:
  • Phone: 405-473-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4024
License Number StateOK

VIII. Authorized Official

Name: DEREK ADCOX
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 405-473-8176