Organization
GRAND SLAM REHABILITATION L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREK PRENTICE (MANAGING MEMBER)
(405) 418-2200
Entity
Organization
Contact information
Practice address
6510 S WESTERN AVE, SUITE 400, OKLAHOMA CITY, OK 73139-1712
(405) 631-8888
(405) 631-9593
Mailing address
6510 S WESTERN AVE, SUITE 400, OKLAHOMA CITY, OK 73139-1712
(405) 631-8888
(405) 631-9593
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
05/27/2006
Last updated
03/09/2012
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