Provider Demographics
NPI:1790354389
Name:CALERA PHYSICAL THERAPY AND SPORT REHAB LLC
Entity Type:Organization
Organization Name:CALERA PHYSICAL THERAPY AND SPORT REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-706-1266
Mailing Address - Street 1:231 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-2115
Mailing Address - Country:US
Mailing Address - Phone:405-706-1266
Mailing Address - Fax:
Practice Address - Street 1:213 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:OK
Practice Address - Zip Code:74730-2115
Practice Address - Country:US
Practice Address - Phone:405-706-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty