Organization
NORTHEASTERN PHYSICAL REHAB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL BRENT SCOTT P.T. (OWNER)
(918) 458-5115
Entity
Organization
Contact information
Practice address
1500 E DOWNING ST STE 210, TAHLEQUAH, OK 74464-3379
(918) 458-5115
(818) 458-5119
Mailing address
1500 E DOWNING ST STE 210, TAHLEQUAH, OK 74464-3379
(918) 458-5115
(818) 458-5119
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1994
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175254900
DEPT OF LABOR
OK
05
—
200022640
—
OK
01
—
650020254
RR MEDICARE
OK
Enumeration date
11/01/2006
Last updated
04/25/2008
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