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General NPI Number Information
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NPI Number | 1083851505
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Entity Type | Organization
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Legal Business Name | PHYSICAL REHABILITATION CENTER OF MUSKOGEE
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 433 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6614
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Country | US
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Telephone | 918-686-8844
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Fax | 918-686-8898
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Provider Business Mailing Address
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Address Line | 433 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-6614
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Country | US
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Telephone | 918-686-8844
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Fax | 918-686-8898
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH RAYMOND TRINIDAD
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Credential | D.O.
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Telephone | 918-742-4881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | OK
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