Provider Demographics
NPI:1427186659
Name:CHISHOLM TRAIL PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:CHISHOLM TRAIL PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EISER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-252-9159
Mailing Address - Street 1:1509 BROOKWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1315
Mailing Address - Country:US
Mailing Address - Phone:580-252-9159
Mailing Address - Fax:580-255-2158
Practice Address - Street 1:1509 BROOKWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1315
Practice Address - Country:US
Practice Address - Phone:580-252-9159
Practice Address - Fax:580-255-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty