Provider Demographics
NPI:1962829523
Name:YUKON WOUND CARE AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:YUKON WOUND CARE AND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-990-6023
Mailing Address - Street 1:9604 S ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-5303
Mailing Address - Country:US
Mailing Address - Phone:405-990-6023
Mailing Address - Fax:405-265-2215
Practice Address - Street 1:1808 COMMONS CIRCLE
Practice Address - Street 2:STE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-265-2255
Practice Address - Fax:405-265-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200535190AMedicaid
OK200134990AMedicaid