Healthcare Provider Details

I. General information

NPI: 1407101413
Provider Name (Legal Business Name): MARLOW THERAPY AND SPORTS REHAB SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N BROADWAY ST
MARLOW OK
73055-1224
US

IV. Provider business mailing address

911 N BROADWAY ST
MARLOW OK
73055-1224
US

V. Phone/Fax

Practice location:
  • Phone: 405-650-7531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3809
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2005
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1618
License Number StateOK

VIII. Authorized Official

Name: MR. ROBERT G. RAINES
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 405-650-7531