Provider Demographics
NPI:1194900530
Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-235-5135
Mailing Address - Street 1:PO BOX 720596
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4444
Mailing Address - Country:US
Mailing Address - Phone:405-292-5500
Mailing Address - Fax:405-292-5505
Practice Address - Street 1:721 NW 6TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1205
Practice Address - Country:US
Practice Address - Phone:405-235-5135
Practice Address - Fax:405-235-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKJ=========7Medicaid