Provider Demographics
NPI:1134152036
Name:SOUTHWEST REHABILITATION
Entity type:Organization
Organization Name:SOUTHWEST REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-636-7452
Mailing Address - Street 1:4221 S WESTERN AVE
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-636-7452
Mailing Address - Fax:405-631-2296
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 3010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-636-7452
Practice Address - Fax:405-631-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10853261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC95264Medicare UPIN