=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861633976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASF OF EDMOND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 03/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 ENZ DR
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-341-0810
-----------------------------------------------------
Fax | 405-341-0976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 POWELL PL
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-369-0620
-----------------------------------------------------
Fax | 615-369-0622
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHRIS COATES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-564-8002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------