MEDICARE: PHYSICAL REHABILITATION CENTER ON MINGO 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467956938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL REHABILITATION CENTER ON MINGO LLC

Provider Business Mailing Address
First Line	:	8165 S MINGO RD STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4667
Country	:	US
Telephone Number	:	918-615-6280
Fax Number	:	918-615-6240

Provider Business Practice Location Address
First Line	:	8165 S MINGO RD STE 101
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-4667
Country	:	US
Telephone Number	:	918-615-6280
Fax Number	:	918-615-6240

Authorized Official
Title or Position	:	MANAGER
Name	:	GAIL M PIANALTO
Credential	:
Telephone Number	:	918-615-6280

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	11/08/2021

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