Basic Information
| Provider Information | |||||||||
| NPI: | 1083130462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWORTWOOD | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PHILLIPS | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | DIANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6600 SOUTH YALE AVE | ||||||||
| Address2: | SUITE 500 ATTN MELISSA LAYWELL | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185028013 | ||||||||
| FaxNumber: | 9185028002 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 N BREWER ST | ||||||||
| Address2: | |||||||||
| City: | VINITA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182569207 | ||||||||
| FaxNumber: | 9182569209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2017 | ||||||||
| LastUpdateDate: | 08/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5371 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.