MEDICARE: ORTHOPEDIC AND SPINE REHAB.INC

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	172M00000X	Mechanotherapist	PT1981	OK

General Provider Information

NPI Number	:	1891971172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND SPINE REHAB.INC

Provider Business Mailing Address
First Line	:	1108 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6001
Country	:	US
Telephone Number	:	405-525-1561
Fax Number	:	405-525-1560

Provider Business Practice Location Address
First Line	:	1108 NW 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6001
Country	:	US
Telephone Number	:	405-525-1561
Fax Number	:	405-525-1560

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. DAVID BRYAN CREEL
Credential	:	LEAD
Telephone Number	:	405-525-1561

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	01/16/2008

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