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General NPI Number Information
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NPI Number | 1285644468
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Entity Type | Organization
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Legal Business Name | MUSKOGEE REHABILITATION AND SPORTS MEDICINE, INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 2421 S YORK ST STE 14
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City | MUSKOGEE
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State | OK
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Zip | 74403-8820
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Country | US
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Telephone | 918-683-8088
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Fax | 918-683-8093
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Provider Business Mailing Address
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Address Line | 2421 S YORK ST STE 14
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City | MUSKOGEE
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State | OK
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Zip | 74403-8820
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Country | US
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Telephone | 918-683-8088
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Fax | 918-683-8093
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK K LABHART
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Credential | PT
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Telephone | 918-683-8088
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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 | INDIVIDUAL THERAPIST
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License Number State | OK
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