Provider Demographics
NPI:1134152911
Name:PROACTIVE THERAPY
Entity type:Organization
Organization Name:PROACTIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-299-9300
Mailing Address - Street 1:10123 SOUTH SHERIDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-299-9300
Mailing Address - Fax:918-299-9305
Practice Address - Street 1:10123 SOUTH SHERIDAN ROAD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-299-9300
Practice Address - Fax:918-299-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty