Provider Demographics
NPI:1548316680
Name:PREHAB PHYSICAL THERAPY CLINIC INC.
Entity type:Organization
Organization Name:PREHAB PHYSICAL THERAPY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:580-355-1766
Mailing Address - Street 1:PO BOX 6626
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0626
Mailing Address - Country:US
Mailing Address - Phone:580-355-1766
Mailing Address - Fax:580-357-8750
Practice Address - Street 1:2716 W GORE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6305
Practice Address - Country:US
Practice Address - Phone:580-355-1766
Practice Address - Fax:580-357-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK655261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK443560173001OtherBCBS
OKO2813Medicare ID - Type Unspecified