Healthcare Provider Details

I. General information

NPI: 1366421794
Provider Name (Legal Business Name): VALIR PAIN MANAGEMENT AND DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N BROADWAY AVE SUITE 400
OKLAHOMA CITY OK
73102-6012
US

IV. Provider business mailing address

825 N BROADWAY AVE SUITE 400
OKLAHOMA CITY OK
73102-6012
US

V. Phone/Fax

Practice location:
  • Phone: 405-609-3600
  • Fax: 405-605-8638
Mailing address:
  • Phone: 405-609-3600
  • Fax: 405-605-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHANNON REGIER
Title or Position: OUTPATIENT COORDINATOR
Credential:
Phone: 405-609-3670