Provider Demographics
NPI:1407032857
Name:REHABILITATION MEDICINE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:YELVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:918-451-5276
Mailing Address - Street 1:PO BOX 2555
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-2555
Mailing Address - Country:US
Mailing Address - Phone:918-451-5276
Mailing Address - Fax:
Practice Address - Street 1:2950 S ELM PL STE 115
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7844
Practice Address - Country:US
Practice Address - Phone:918-451-5276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19953283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital