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General NPI Number Information
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NPI Number | 1225702996
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Entity Type | Organization
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Legal Business Name | LIFE RESTORATION PLACE LLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 1211 N SHARTEL AVE STE 801
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2425
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Country | US
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Telephone | 405-504-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 14433 LOCUST ST
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City | PIEDMONT
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State | OK
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Zip | 73078-8910
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Country | US
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Telephone | 405-488-7543
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | LEE GERMANY
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Credential | PA-C
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Telephone | 405-488-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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