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General NPI Number Information
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NPI Number | 1790969053
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Entity Type | Organization
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Legal Business Name | SOUTH TULSA PERFORMANCE HEALTH
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 7112 S MINGO RD STE 101
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City | TULSA
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State | OK
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Zip | 74133-3267
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Country | US
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Telephone | 918-949-6622
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Fax | 918-872-9913
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Provider Business Mailing Address
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Address Line | 7112 S MINGO RD STE 101
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City | TULSA
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State | OK
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Zip | 74133-3267
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Country | US
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Telephone | 918-949-6622
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Fax | 918-872-9913
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON COOK
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Credential | D.C.
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Telephone | 918-949-6622
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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 | 3785
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License Number State | OK
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