Organization
REDBUD PHYSICAL REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON CARTER (HUMAN RESOURCES)
(918) 622-4126
Entity
Organization
Contact information
Practice address
4008 S YALE AVE, TULSA, OK 74135-6017
(918) 622-4278
(918) 622-4844
Mailing address
4812 E 33RD ST, TULSA, OK 74135-2038
(918) 622-4126
(918) 270-2398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200034500A
MEDICAID LEGACY
OK
05
—
200034500A
—
OK
05
—
200034500B
—
OK
05
—
200034500C
—
OK
05
—
200034500D
—
OK
05
—
200034500E
—
OK
05
—
200034500F
—
OK
05
—
200034500G
—
OK
05
—
200034500H
—
OK
05
—
200034500I
—
OK
01
—
700522061
MEDICARE
OK
01
—
CJ4389
MEDICARE RAILROAD
—
Enumeration date
10/11/2005
Last updated
05/05/2011
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