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General NPI Number Information
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NPI Number | 1346405776
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Entity Type | Organization
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Legal Business Name | PHYSICIANS PHYSICAL THERAPY SERVICE, INC.
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 1617 N CANARY DR
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City | EDMOND
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State | OK
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Zip | 73034-6123
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Country | US
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Telephone | 405-340-1022
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Fax | 405-340-1022
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Provider Business Mailing Address
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Address Line | 1617 N CANARY DR
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City | EDMOND
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State | OK
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Zip | 73034-6123
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Country | US
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Telephone | 405-340-1022
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Fax | 405-340-1022
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. JOHN T. PELLOW
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Credential | P.T.
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Telephone | 405-340-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 42
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License Number State | OK
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