Organization
THERAWEST LLC
Active
Other names
TheraWest Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
LORA ANN RUIZ (BILLING SPECIALIST)
(580) 275-2194
Entity
Organization
Contact information
Practice address
509 S 30TH ST, CLINTON, OK 73601-3632
(580) 323-8778
(866) 490-4693
Mailing address
PO BOX 86, CLINTON, OK 73601-0086
(580) 323-8778
(866) 490-4693
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2536
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200068650 A
—
OK
01
—
445844020003
BCBS OF OKLAHOMA
OK
Enumeration date
04/13/2007
Last updated
03/02/2026
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