# IGNITE SPORTS AND REHAB OF ARDMORE INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629452149
- **Authorized official:** BRIAN MARK TREADWELL (CEO / OWNER)
- **Authorized official phone:** (580) 490-3312

## Contact information

- **Practice address:** 908 N ROCKFORD RD, SUITE C, ARDMORE, OK 73401-2540
- **Practice address phone:** (580) 490-3312
- **Practice address fax:** (580) 490-3318
- **Mailing address:** 908 N ROCKFORD RD, SUITE C, ARDMORE, OK 73401-2540
- **Mailing address phone:** (580) 490-3312
- **Mailing address fax:** (580) 490-3318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251S0007X | Sports Physical Therapist | 4555 | OK | Yes |

## Other

- **Enumeration date:** 07/14/2015
- **Last updated:** 07/14/2015