Provider Demographics
NPI:1346405776
Name:PHYSICIANS PHYSICAL THERAPY SERVICE, INC.
Entity Type:Organization
Organization Name:PHYSICIANS PHYSICAL THERAPY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-340-1022
Mailing Address - Street 1:1617 N CANARY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6123
Mailing Address - Country:US
Mailing Address - Phone:405-340-1022
Mailing Address - Fax:405-340-1022
Practice Address - Street 1:1617 N CANARY DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6123
Practice Address - Country:US
Practice Address - Phone:405-340-1022
Practice Address - Fax:405-340-1022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIANS PHYSICAL THERAPY SERVICE,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty