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General NPI Number Information
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NPI Number | 1366824047
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Entity Type | Organization
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Legal Business Name | INTEGRIS
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 310 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6743
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Country | US
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Telephone | 918-540-7736
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Fax | 918-540-7739
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Provider Business Mailing Address
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Address Line | 310 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6743
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Country | US
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Telephone | 918-540-7736
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Fax | 918-540-7739
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | SUSANN MARIE MONTGOMERY
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Credential | PT
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Telephone | 918-540-7736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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