Provider Demographics
NPI:1922558766
Name:NORTHWEST THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:NORTHWEST THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JANTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:580-554-7065
Mailing Address - Street 1:309 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4519
Mailing Address - Country:US
Mailing Address - Phone:580-297-5147
Mailing Address - Fax:580-297-7011
Practice Address - Street 1:309 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4519
Practice Address - Country:US
Practice Address - Phone:580-297-5147
Practice Address - Fax:580-297-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty