1780754705 NPI number — DURANT PHYSICAL THERAPY INC, PC

Table of content: (NPI 1780754705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780754705 NPI number — DURANT PHYSICAL THERAPY INC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURANT PHYSICAL THERAPY INC, 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:
DURANT PHYSICAL THERAPY
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:
1780754705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3004 W UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74701-2998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-920-2231
Provider Business Mailing Address Fax Number:
580-920-2242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3004 W UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
DURANT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74701-2998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-920-2231
Provider Business Practice Location Address Fax Number:
580-920-2242
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARPER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
OWNER/PT
Authorized Official Telephone Number:
580-920-2231

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2379 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT2365 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1133726 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200057810A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD5543 . This is a "RR MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 611622500 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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