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General NPI Number Information
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NPI Number | 1972831550
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Entity Type | Organization
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Legal Business Name | ENVIDA REHABILITATION LLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 8222 E 103RD ST SUITE 127
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City | TULSA
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State | OK
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Zip | 74133-7081
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Country | US
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Telephone | 918-369-9100
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Fax | 918-369-9050
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Provider Business Mailing Address
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Address Line | 8222 E 103RD ST SUITE 127
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City | TULSA
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State | OK
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Zip | 74133-7081
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Country | US
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Telephone | 918-369-9100
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Fax | 918-369-9050
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | LEON MARTINEZ
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Credential |
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Telephone | 918-369-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1939
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License Number State | OK
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