Healthcare Provider Details

I. General information

NPI: 1861633976
Provider Name (Legal Business Name): ASF OF EDMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ENZ DR
EDMOND OK
73034-4436
US

IV. Provider business mailing address

205 POWELL PL
BRENTWOOD TN
37027-7522
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-0810
  • Fax: 405-341-0976
Mailing address:
  • Phone: 615-369-0620
  • Fax: 615-369-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRIS COATES
Title or Position: PRESIDENT
Credential:
Phone: 615-564-8002