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General NPI Number Information
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NPI Number | 1437158318
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Entity Type | Organization
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Legal Business Name | MIDSTATE REHAB LLC
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 114 S ASH ST
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City | GUTHRIE
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State | OK
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Zip | 73044-4908
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Country | US
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Telephone | 405-282-2005
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Fax | 405-282-2129
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Provider Business Mailing Address
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Address Line | 114 S ASH ST
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City | GUTHRIE
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State | OK
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Zip | 73044-4908
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Country | US
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Telephone | 405-282-2005
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Fax | 405-282-2129
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TANDIE HASTINGS
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Credential |
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Telephone | 405-282-6285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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