Healthcare Provider Details

I. General information

NPI: 1982186169
Provider Name (Legal Business Name): JOC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S DOUGLAS BLVD STE C
MIDWEST CITY OK
73130-5245
US

IV. Provider business mailing address

1201 S DOUGLAS BLVD STE H
MIDWEST CITY OK
73130-5263
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-5555
  • Fax: 405-737-5556
Mailing address:
  • Phone: 405-732-7777
  • Fax: 405-610-7785

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: MISS KIM NELSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 405-590-2940