Northeastern Physical Rehab

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2083 Issued in OK

Legal business name

NORTHEASTERN PHYSICAL REHAB

Practice address

2021 Mahaney Ave Ste 6
Tahlequah, OK 74464-5795

Phone

(918) 458-5115

Fax

(918) 458-5119

NPI assigned

Dec 14, 2011

Last updated

Dec 14, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carl Brent Scott, PTNPI 1194768655

Title

Physical Therapist

Phone

(918) 458-5115

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carl Brent Scott, PT

  • Physical Therapist
  • Tahlequah, OK
  • NPI 1194768655
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1275802639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 MAHANEY AVE STE 6",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645795",
            "telephone_number": "918-458-5115",
            "fax_number": "918-458-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 MAHANEY AVE STE 6",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645795",
            "telephone_number": "918-458-5115",
            "fax_number": "918-458-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN PHYSICAL REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "918-458-5115",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OK",
            "license": "2083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northeastern Oklahoma Community Health Centers, Inc (NeoHealth)
• Northeastern Oklahoma Community Health Centers, Inc. (Tahlequah Primary Care)
• Northeastern Oklahoma Community Health Centers, Inc. (Tahlequah ENT)
• Northeastern Oklahoma Community Health Centers, Inc. (NeoHealth Medical Center)
• Northeastern Oklahoma Community Health Centers, Inc. (Tahlequah Family Practice)
• Northeastern Physical Rehab, Inc.
• Northeastern Speech Therapy, PLLC
• Northeastern State University (Northeastern State University Sports Medicine)
• Northeastern State University College of Optometry
• Northeastern State University College of Optometry

• Physical Therapy Clinic/Center in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Physical Therapy Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.