Organization
ABC PEDIATRIC REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS VICTORIA ALVARADO PTA (OWNER/PTA)
(405) 845-3389
Entity
Organization
Contact information
Practice address
508 W I 240 SERVICE RD, OKLAHOMA CITY, OK 73139-4400
(405) 724-9303
(405) 724-9617
Mailing address
1808 DOROTHY DR, MOORE, OK 73170-1457
(405) 570-2672
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225700000X
Massage Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200950830A
—
OK
Enumeration date
10/19/2020
Last updated
04/07/2021
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