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General NPI Number Information
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NPI Number | 1932101946
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Entity Type | Organization
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Legal Business Name | FIRSTCARE REHABILITATION, INC.
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 1725 S HIGHWAY 183 SUITE 100
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City | CLINTON
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State | OK
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Zip | 73601-9533
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Country | US
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Telephone | 580-323-1682
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Fax | 580-323-1711
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | CLINTON
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State | OK
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Zip | 73601-0334
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Country | US
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Telephone | 580-323-1682
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Fax | 580-323-1711
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. LONNIE BRAND HARTSELL
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Credential |
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Telephone | 580-323-1682
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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 | PT2120
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License Number State | OK
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