Provider Demographics
NPI:1194863373
Name:NORTHERN THERAPY & REHABILITATION, INC
Entity Type:Organization
Organization Name:NORTHERN THERAPY & REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-765-0101
Mailing Address - Street 1:706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-3825
Mailing Address - Country:US
Mailing Address - Phone:580-765-0101
Mailing Address - Fax:580-765-3434
Practice Address - Street 1:706 S 1ST ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-3825
Practice Address - Country:US
Practice Address - Phone:580-765-0101
Practice Address - Fax:580-765-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty