Provider Demographics
NPI:1336167204
Name:REGIONAL PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:REGIONAL PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-732-3353
Mailing Address - Street 1:9309 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3321
Mailing Address - Country:US
Mailing Address - Phone:405-732-3353
Mailing Address - Fax:405-732-3397
Practice Address - Street 1:9309 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3321
Practice Address - Country:US
Practice Address - Phone:405-732-3353
Practice Address - Fax:405-732-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6238220001Medicare NSC
OK500522047Medicare ID - Type Unspecified