# OKLAHOMA PAIN & REHAB LLC

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

## Provider details

- **NPI number:** 1710277207
- **Authorized official:** KIM RYAN (OWNER)
- **Authorized official phone:** (405) 926-7926

## Contact information

- **Practice address:** 2121 S COLUMBIA AVE, SUITE 501, TULSA, OK 74114-3505
- **Practice address phone:** (918) 747-0716
- **Mailing address:** 2121 S COLUMBIA AVE, SUITE 501, TULSA, OK 74114-3505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/18/2011
- **Last updated:** 06/13/2012