NPIMap

Organization Active NPI

Northeastern Physical Rehab, Inc.

  • Physical Therapist
  • Tahlequah, OK
National Provider Identifier
1447337423
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1994 Issued in OK
Legal business name
NORTHEASTERN PHYSICAL REHAB, INC.
Practice address
1500 E Downing St Ste 210
Tahlequah, OK 74464-3379
Phone
(918) 458-5115
Fax
(818) 458-5119
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2008

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

Authorized official

Name
Mr. Carl Brent Scott, P.T.NPI 1194768655
Title
Owner
Phone
(918) 458-5115

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 1994 OK Primary

Addresses

Primary practice location

1500 E Downing St Ste 210
Tahlequah, OK 74464-3379

Mailing address

1500 E Downing St Ste 210
Tahlequah, OK 74464-3379
Phone (918) 458-5115

Other identifiers 3

IdentifierTypeStateIssuer
175254900OtherOKDEPT OF LABOR
200022640MedicaidOK
650020254OtherOKRR MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1447337423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E DOWNING ST STE 210",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643379",
            "telephone_number": "918-458-5115",
            "fax_number": "818-458-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E DOWNING ST STE 210",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643379",
            "telephone_number": "918-458-5115",
            "fax_number": "818-458-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN PHYSICAL REHAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-458-5115",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "1994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "175254900",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200022640",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "650020254",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; 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.