Healthcare Provider Details

I. General information

NPI: 1447480082
Provider Name (Legal Business Name): SUMMIT REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W LILLIE BLVD
MADILL OK
73446-1270
US

IV. Provider business mailing address

1405 4TH AVE NW #296
ARDMORE OK
73401
US

V. Phone/Fax

Practice location:
  • Phone: 580-872-4277
  • Fax: 580-872-4261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN WLODARCZYK
Title or Position: CFO
Credential:
Phone: 580-226-5566