Provider Demographics
NPI:1629684972
Name:THERA-BRAND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:THERA-BRAND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:580-336-8598
Mailing Address - Street 1:24051 COUNTY ROAD 80
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-9214
Mailing Address - Country:US
Mailing Address - Phone:580-336-8598
Mailing Address - Fax:
Practice Address - Street 1:24051 COUNTY ROAD 80
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-9214
Practice Address - Country:US
Practice Address - Phone:580-336-8598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy