# STRUCTURAL REHAB

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

## Provider details

- **NPI number:** 1891860615
- **Authorized official:** DR. TRACY L. STANDRIDGE D.C. (OWNER)
- **Authorized official phone:** (918) 272-7491

## Contact information

- **Practice address:** 12707 EAST 86TH STREET NORTH, OWASSO, OK 74055
- **Practice address phone:** (918) 272-7491
- **Practice address fax:** (918) 272-7491
- **Mailing address:** 12707 EAST 86TH STREET NORTH, OWASSO, OK 74055
- **Mailing address phone:** (918) 272-7491
- **Mailing address fax:** (918) 272-7448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 08/22/2020