Provider Demographics
NPI:1366421794
Name:VALIR PAIN MANAGEMENT AND DEVELOPMENT, LLC
Entity type:Organization
Organization Name:VALIR PAIN MANAGEMENT AND DEVELOPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:REGIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-3670
Mailing Address - Street 1:825 N BROADWAY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6012
Mailing Address - Country:US
Mailing Address - Phone:405-609-3600
Mailing Address - Fax:405-605-8638
Practice Address - Street 1:825 N BROADWAY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-6012
Practice Address - Country:US
Practice Address - Phone:405-609-3600
Practice Address - Fax:405-605-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9005222451Medicare ID - Type Unspecified