Basic Information
| Provider Information | |||||||||
| NPI: | 1063707875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRO THERAPY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 NW 63RD ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731161935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056084308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3705 NW 63RD ST | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731161935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056084308 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | CHAFFEE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4056084308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3454 | OK | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.