Healthcare Provider Details

I. General information

NPI: 1770799413
Provider Name (Legal Business Name): COMPLETE REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MUSTANG RD SUITE B
YUKON OK
73099-7315
US

IV. Provider business mailing address

424 S MUSTANG RD SUITE B
YUKON OK
73099-7315
US

V. Phone/Fax

Practice location:
  • Phone: 405-324-0961
  • Fax: 405-324-0971
Mailing address:
  • Phone: 405-324-0961
  • Fax: 405-324-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2273
License Number StateOK

VIII. Authorized Official

Name: MS. RHONDA LYNN RACKLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-324-0961