Provider Demographics
NPI:1275759664
Name:FOUR STATE REHABILITATION
Entity Type:Organization
Organization Name:FOUR STATE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:918-286-1261
Mailing Address - Street 1:2208 N YELLOWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9102
Mailing Address - Country:US
Mailing Address - Phone:918-286-1261
Mailing Address - Fax:918-286-1265
Practice Address - Street 1:2208 N YELLOWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9102
Practice Address - Country:US
Practice Address - Phone:918-286-1261
Practice Address - Fax:918-286-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty