Organization
TOTAL POSS-ABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON ROBERSON MOTR/L (EXECUTIVE DIRECTOR)
(405) 607-4440
Entity
Organization
Contact information
Practice address
301 S BOULEVARD STE 126, EDMOND, OK 73034-3880
(405) 607-4440
Mailing address
301 S BOULEVARD, EDMOND, OK 73034-3878
(405) 607-4440
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
OT1522
OK
Other
Enumeration date
08/25/2010
Last updated
08/25/2010
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