Provider Demographics
NPI:1215328752
Name:RIVERMARK PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:RIVERMARK PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-413-3326
Mailing Address - Street 1:14501 DURANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7315
Mailing Address - Country:US
Mailing Address - Phone:918-413-3326
Mailing Address - Fax:918-649-0028
Practice Address - Street 1:14501 DURANT HILL RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-7315
Practice Address - Country:US
Practice Address - Phone:918-413-3326
Practice Address - Fax:918-649-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty