Healthcare Provider Details

I. General information

NPI: 1609060540
Provider Name (Legal Business Name): PHYSICAL REHABILITATION ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 NW 47TH ST SUITE D
OKLAHOMA CITY OK
73118-6400
US

IV. Provider business mailing address

1024 NW 47TH ST SUITE D
OKLAHOMA CITY OK
73118-6400
US

V. Phone/Fax

Practice location:
  • Phone: 405-606-2007
  • Fax: 405-606-2008
Mailing address:
  • Phone: 405-606-2007
  • Fax: 405-606-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1300
License Number StateOK

VIII. Authorized Official

Name: ROBERT A ESKEW
Title or Position: OWNER
Credential: PT
Phone: 405-606-2007