Organization · NPI-2

Abc Pediatric Rehab LLC

Clinic/Center, Physical Therapy · Oklahoma City, OK

NPI number1679172993
StatusActive
Last updated in NPPESApr 7, 2021

Details

NPI
1679172993
Entity type
Organization (NPI-2)
Legal business name
Abc Pediatric Rehab LLC
Organization subpart
No
Enumeration date
Oct 19, 2020
Certification date
Apr 7, 2021
Last updated
Apr 7, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2000X Clinic/Center, Physical Therapy––Yes
2080S0010X Pediatrics, Sports Medicine––
2251P0200X Physical Therapist, Pediatrics––
225200000X Physical Therapy Assistant––
225700000X Massage Therapist––

Practice location

508 W I 240 Service Rd
Oklahoma City, OK 73139-4400

Phone 405-724-9303 · Fax 405-724-9617

Mailing address

1808 Dorothy Dr
Moore, OK 73170-1457

Phone 405-570-2672

Other practice locations

1808 Dorothy Dr
Moore, OK 73170-1457

Phone 405-570-2672

Authorized official

Victoria Alvarado
Owner/Pta
4058453389

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