Provider Demographics
NPI:1972050052
Name:ADA MEDICAL INC
Entity Type:Organization
Organization Name:ADA MEDICAL INC
Other - Org Name:ADA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:580-332-3353
Mailing Address - Street 1:15269 COUNTY ROAD 3610
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-332-3353
Mailing Address - Fax:580-332-3053
Practice Address - Street 1:1414 ARLINGTON STREET
Practice Address - Street 2:SUITE 2300
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-332-3353
Practice Address - Fax:580-332-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1427293448OtherNPI