Organization
ACTIVE REHAB CLINIC
Active
Organization
ACTIVE REHAB CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATOSHIA DENISE HARDISON PT, DPT (CEO)
(405) 209-0692
Entity
Organization
Contact information
Practice address
8720 S PENNSYLVANIA AVE STE B, OKLAHOMA CITY, OK 73159-5237
(405) 209-0692
Mailing address
6929 S SOONER RD APT 43101, OKLAHOMA CITY, OK 73135-2739
(405) 209-0692
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/22/2019
Last updated
08/14/2023
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