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General NPI Number Information
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NPI Number | 1548316680
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Entity Type | Organization
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Legal Business Name | PREHAB PHYSICAL THERAPY CLINIC INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 2716 W GORE BLVD SUITE D
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City | LAWTON
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State | OK
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Zip | 73505-6305
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Country | US
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Telephone | 580-355-1766
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Fax | 580-357-8750
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Provider Business Mailing Address
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Address Line | PO BOX 6626
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City | LAWTON
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State | OK
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Zip | 73506-0626
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Country | US
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Telephone | 580-355-1766
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Fax | 580-357-8750
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. RUTH M ROSS
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Credential | R.P.T.
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Telephone | 580-355-1766
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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 | 655
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License Number State | OK
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