Provider Demographics
NPI:1861416430
Name:MID-DEL PHYSICAL THERAPY CLINIC INC.
Entity type:Organization
Organization Name:MID-DEL PHYSICAL THERAPY CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:DANELL
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-209-4560
Mailing Address - Street 1:PO BOX 15171
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73155-5171
Mailing Address - Country:US
Mailing Address - Phone:405-209-4560
Mailing Address - Fax:
Practice Address - Street 1:2825 EPPERLY DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3319
Practice Address - Country:US
Practice Address - Phone:405-209-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100741820AMedicaid