Provider Demographics
NPI:1013046408
Name:DRIZ REHAB GROUP, PROFESSIONAL LTD. CO.
Entity Type:Organization
Organization Name:DRIZ REHAB GROUP, PROFESSIONAL LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:APACIBLE
Authorized Official - Last Name:DRIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:918-384-0088
Mailing Address - Street 1:7135 S BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6302
Mailing Address - Country:US
Mailing Address - Phone:918-384-0088
Mailing Address - Fax:918-384-0044
Practice Address - Street 1:7135 S BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6302
Practice Address - Country:US
Practice Address - Phone:918-384-0088
Practice Address - Fax:918-384-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty