Provider Demographics
NPI:1639617996
Name:ADAPT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ADAPT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOX
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-473-8176
Mailing Address - Street 1:19205 GREENERY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-9644
Mailing Address - Country:US
Mailing Address - Phone:405-473-8176
Mailing Address - Fax:
Practice Address - Street 1:19205 GREENERY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9644
Practice Address - Country:US
Practice Address - Phone:405-473-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy