Healthcare Provider Details

I. General information

NPI: 1770455651
Provider Name (Legal Business Name): COMPLETE RECOVERY PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N GUM ST
JENKS OK
74037-2530
US

IV. Provider business mailing address

707 N GUM ST
JENKS OK
74037-2530
US

V. Phone/Fax

Practice location:
  • Phone: 918-938-3521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DR. TYLER AUSTIN ROBERTS
Title or Position: OWNER
Credential: DPT
Phone: 918-938-3521