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NPI Code Detail

MEDICARE: NORTHWEST PHYSICAL THERAPY AND SPORTS REHAB, LLC

MEDICARE: NORTHWEST PHYSICAL THERAPY AND SPORTS REHAB, 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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1497067771
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST PHYSICAL THERAPY AND SPORTS REHAB, LLC
Provider Business Mailing Address
First Line : 2630 OKLAHOMA AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-4010
Country : US
Telephone Number : 580-256-2102
Fax Number : 580-256-1410
Provider Business Practice Location Address
First Line : 2630 OKLAHOMA AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-4010
Country : US
Telephone Number : 580-256-2102
Fax Number : 580-256-1410
Authorized Official
Title or Position : OWNER/ADMINISTRATOR
Name : JON ARRON WHITE
Credential : PT
Telephone Number : 580-256-2102
Provider Enumeration Date : 07/02/2010
Last Update Date : 08/17/2017

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