Provider Demographics
NPI:1538439286
Name:INTEGRIS JIM THORPE REHABILITATION MOORE
Entity type:Organization
Organization Name:INTEGRIS JIM THORPE REHABILITATION MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-559-8498
Mailing Address - Street 1:2111 RIVERWALK DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2700
Mailing Address - Country:US
Mailing Address - Phone:405-793-7885
Mailing Address - Fax:405-793-7893
Practice Address - Street 1:2111 RIVERWALK DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2700
Practice Address - Country:US
Practice Address - Phone:405-793-7885
Practice Address - Fax:405-793-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA73261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy