1740283449 NPI number — THERAPY IN MOTION PC

Table of content: (NPI 1740283449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740283449 NPI number — THERAPY IN MOTION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY IN MOTION PC
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:
THERAPY IN MOTION
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:
1740283449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2475 BOARDWALK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-6332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-447-1991
Provider Business Mailing Address Fax Number:
405-447-1198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 NW 32ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73065-6589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-392-3322
Provider Business Practice Location Address Fax Number:
405-392-3356
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANNESLEY
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
405-447-1991

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 175206601 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200020850B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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