Provider Demographics
NPI:1609060540
Name:PHYSICAL REHABILITATION ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PHYSICAL REHABILITATION ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESKEW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-606-2007
Mailing Address - Street 1:1024 NW 47TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6400
Mailing Address - Country:US
Mailing Address - Phone:405-606-2007
Mailing Address - Fax:405-606-2008
Practice Address - Street 1:1024 NW 47TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6400
Practice Address - Country:US
Practice Address - Phone:405-606-2007
Practice Address - Fax:405-606-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPT1300OtherSTATE LICENSE