Provider Demographics
NPI:1720153638
Name:NEO ORTHOPEDIC AND REHABILITATION LLC
Entity Type:Organization
Organization Name:NEO ORTHOPEDIC AND REHABILITATION LLC
Other - Org Name:NEO ORTHOPEDICS AND REHABILITATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASSIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYKELLYN
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:FUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-542-4101
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0168
Mailing Address - Country:US
Mailing Address - Phone:918-542-4101
Mailing Address - Fax:918-542-4410
Practice Address - Street 1:2225 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1620
Practice Address - Country:US
Practice Address - Phone:918-542-4101
Practice Address - Fax:918-542-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty