| NPI | 1629489612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ELLIS Member 405-664-7622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 207R00000X Internal Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 225100000X Physical Therapist | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2018-04-23 |