Provider Demographics
NPI:1235797549
Name:DR BRIANNA TEEL REHAB SERVICES LLC
Entity Type:Organization
Organization Name:DR BRIANNA TEEL REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-492-7545
Mailing Address - Street 1:6639 S 224TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-6644
Mailing Address - Country:US
Mailing Address - Phone:979-492-7545
Mailing Address - Fax:
Practice Address - Street 1:1200 W ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8146
Practice Address - Country:US
Practice Address - Phone:918-957-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522420AMedicaid