1700912615 NPI number — PIEDMONT THERAPY INSTITUTE

Table of content: (NPI 1700912615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700912615 NPI number — PIEDMONT THERAPY INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT THERAPY INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OKLAHOMA THERAPY INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700912615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73101-3076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-606-3311
Provider Business Mailing Address Fax Number:
405-606-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2240 N CLASSEN BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73106-5811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-606-3311
Provider Business Practice Location Address Fax Number:
405-606-3081
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-606-3311

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT3941 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT645 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200073370A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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