Healthcare Provider Details

I. General information

NPI: 1285644468
Provider Name (Legal Business Name): MUSKOGEE REHABILITATION AND SPORTS MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 S YORK ST STE 14
MUSKOGEE OK
74403-8820
US

IV. Provider business mailing address

2421 S YORK ST STE 14
MUSKOGEE OK
74403-8820
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-8088
  • Fax: 918-683-8093
Mailing address:
  • Phone: 918-683-8088
  • Fax: 918-683-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberINDIVIDUAL THERAPIST
License Number StateOK

VIII. Authorized Official

Name: MARK K LABHART
Title or Position: PRESIDENT
Credential: PT
Phone: 918-683-8088