Organization
ELITE THERAPY GROUPS OF TEXAS COUNTY, L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTI L. COOPER-JOHNSON RPT (OWNER)
(580) 338-4676
Entity
Organization
Contact information
Practice address
1311 N MAIN ST, GUYMON, OK 73942-3303
(580) 338-4676
(580) 338-4686
Mailing address
1311 N MAIN ST, GUYMON, OK 73942-3303
(580) 338-4676
(580) 338-4686
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900522375
MEDICARE PTAN
OK
Enumeration date
05/19/2006
Last updated
12/02/2021
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