Provider Demographics
NPI:1700912615
Name:PIEDMONT THERAPY INSTITUTE
Entity Type:Organization
Organization Name:PIEDMONT THERAPY INSTITUTE
Other - Org Name:OKLAHOMA THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:405-606-3311
Mailing Address - Street 1:PO BOX 3076
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-3076
Mailing Address - Country:US
Mailing Address - Phone:405-606-3311
Mailing Address - Fax:405-606-3081
Practice Address - Street 1:2240 N CLASSEN BLVD
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5811
Practice Address - Country:US
Practice Address - Phone:405-606-3311
Practice Address - Fax:405-606-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3941225100000X
OKOT645225X00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200073370AMedicaid
OK400522355Medicare ID - Type UnspecifiedGROUP NUMBER