Provider Demographics
NPI:1679769285
Name:SOUTHWEST OKLAHOMA PT ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHWEST OKLAHOMA PT ASSOCIATES LLC
Other - Org Name:REBOUND OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-8888
Mailing Address - Street 1:6510 S WESTERN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1712
Mailing Address - Country:US
Mailing Address - Phone:405-631-8888
Mailing Address - Fax:405-631-9593
Practice Address - Street 1:100 S PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5750
Practice Address - Country:US
Practice Address - Phone:580-482-9159
Practice Address - Fax:580-482-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty