Organization
IGNITE PERFORMANCE CENTER AND SPORTS REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE EDDIE DEWBRE (OWNER/MANAGER)
(409) 392-7628
Entity
Organization
Contact information
Practice address
313 MAIN STREET, VELMA, OK 73491-9998
(409) 392-7628
Mailing address
PO BOX 298, VELMA, OK 73491-0298
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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