Provider Demographics
NPI:1891971172
Name:ORTHOPEDIC AND SPINE REHAB.INC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPINE REHAB.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:LEAD
Authorized Official - Phone:405-525-1561
Mailing Address - Street 1:1108 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6001
Mailing Address - Country:US
Mailing Address - Phone:405-525-1561
Mailing Address - Fax:405-525-1560
Practice Address - Street 1:1108 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6001
Practice Address - Country:US
Practice Address - Phone:405-525-1561
Practice Address - Fax:405-525-1560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC AND SPINE REHAB.INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1981172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty