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General NPI Number Information
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NPI Number | 1639617996
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Entity Type | Organization
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Legal Business Name | ADAPT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 19205 GREENERY LN
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City | EDMOND
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State | OK
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Zip | 73012-9644
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Country | US
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Telephone | 405-473-8176
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Fax |
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Provider Business Mailing Address
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Address Line | 19205 GREENERY LN
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City | EDMOND
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State | OK
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Zip | 73012-9644
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Country | US
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Telephone | 405-473-8176
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DEREK ADCOX
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Credential | PT
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Telephone | 405-473-8176
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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 | 4024
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License Number State | OK
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