Provider Demographics
NPI:1467753913
Name:CORE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:TOD
Authorized Official - Last Name:TREGONING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-381-9024
Mailing Address - Street 1:4705 W URBANA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5998
Mailing Address - Country:US
Mailing Address - Phone:918-381-9024
Mailing Address - Fax:918-518-6510
Practice Address - Street 1:4705 W URBANA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5998
Practice Address - Country:US
Practice Address - Phone:918-381-9024
Practice Address - Fax:918-518-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy