Healthcare Provider Details

I. General information

NPI: 1447219001
Provider Name (Legal Business Name): RED RIVER REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N 1ST ST
MADILL OK
73446-1489
US

IV. Provider business mailing address

105 N 5TH AVE
MADILL OK
73446-1203
US

V. Phone/Fax

Practice location:
  • Phone: 580-677-9949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOK

VIII. Authorized Official

Name: LONI TAYLOR
Title or Position: MARKETING/RECRUITING
Credential:
Phone: 580-795-3301