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Organization
PEDIATRIC REHABILITATIVE ORTHOTIC SERVICES LTD CO
Active
Organization
PEDIATRIC REHABILITATIVE ORTHOTIC SERVICES LTD CO
Active
Other names
PROS
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN THIES (OFFICE MANAGER)
(918) 518-5980
Entity
Organization
Contact information
Practice address
480 E 141ST ST STE E, GLENPOOL, OK 74033-3550
(918) 518-5980
(918) 518-5982
Mailing address
480 E 141ST ST STE E, GLENPOOL, OK 74033-3550
(918) 518-5980
(918) 518-5982
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
11
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200069410A
—
OK
05
—
200748390A
—
KS
Enumeration date
11/01/2012
Last updated
08/22/2019
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