MEDICARE: THERAWEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2536	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	445844020003	OTHER	OK	BCBS OF OKLAHOMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114142486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAWEST LLC

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-0086
Country	:	US
Telephone Number	:	580-323-8778
Fax Number	:	866-490-4693

Provider Business Practice Location Address
First Line	:	509 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3632
Country	:	US
Telephone Number	:	580-323-8778
Fax Number	:	866-490-4693

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	LORA ANN RUIZ
Credential	:
Telephone Number	:	580-275-2194

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	03/02/2026

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Directions to “THERAWEST LLC ” Practice Location

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