Provider Demographics
NPI:1982186169
Name:JOC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:JOC PHYSICAL THERAPY LLC
Other - Org Name:FULL FUNCTION REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-590-2940
Mailing Address - Street 1:1201 S DOUGLAS BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5263
Mailing Address - Country:US
Mailing Address - Phone:405-732-7777
Mailing Address - Fax:405-610-7785
Practice Address - Street 1:1113 S DOUGLAS BLVD STE C
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5245
Practice Address - Country:US
Practice Address - Phone:405-737-5555
Practice Address - Fax:405-737-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy