Provider Demographics
NPI:1972831550
Name:ENVIDA REHABILITATION LLC
Entity Type:Organization
Organization Name:ENVIDA REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-369-9100
Mailing Address - Street 1:8222 E 103RD ST
Mailing Address - Street 2:SUITE 127
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7081
Mailing Address - Country:US
Mailing Address - Phone:918-369-9100
Mailing Address - Fax:918-369-9050
Practice Address - Street 1:8222 E 103RD ST
Practice Address - Street 2:SUITE 127
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7081
Practice Address - Country:US
Practice Address - Phone:918-369-9100
Practice Address - Fax:918-369-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty