Provider Demographics
NPI:1679748495
Name:PHYSIATRY SERVICES INC
Entity Type:Organization
Organization Name:PHYSIATRY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-351-2900
Mailing Address - Street 1:19468 SW COOMBS RD
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-4824
Mailing Address - Country:US
Mailing Address - Phone:972-351-2900
Mailing Address - Fax:
Practice Address - Street 1:19468 SW COOMBS RD
Practice Address - Street 2:
Practice Address - City:CACHE
Practice Address - State:OK
Practice Address - Zip Code:73527-4824
Practice Address - Country:US
Practice Address - Phone:972-351-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty