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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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