NPIMap

Organization Active NPI

Northwest Physical Therapy and Sports Rehab, LLC

  • Physical Therapy Clinic/Center
  • Woodward, OK
National Provider Identifier
1497067771
Registry record updated Aug 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
NORTHWEST PHYSICAL THERAPY AND SPORTS REHAB, LLC
Practice address
2630 Oklahoma Ave
Woodward, OK 73801-4010
Phone
(580) 256-2102
Fax
(580) 256-1410
NPI assigned
Jul 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2017

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

Authorized official

Name
Jon Arron White, PTNPI 1780995795
Title
Owner/Administrator
Phone
(580) 256-2102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2630 Oklahoma Ave
Woodward, OK 73801-4010

Mailing address

2630 Oklahoma Ave
Woodward, OK 73801-4010
Phone (580) 256-2102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110505000315 OK Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7113102294 Receives reassigned benefits from 5 practitioners
Practice locations: Woodward, OK

National Provider Directory

National Provider Directory

Locations

2630 Oklahoma Ave
Woodward, OK 73801
Phone (580) 256-2102

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502928000000",
    "number": "1497067771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 OKLAHOMA AVE",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738014010",
            "telephone_number": "580-256-2102",
            "fax_number": "580-256-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 OKLAHOMA AVE",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738014010",
            "telephone_number": "580-256-2102",
            "fax_number": "580-256-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PHYSICAL THERAPY AND SPORTS REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-02",
        "last_updated": "2017-08-17",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "ARRON",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "580-256-2102",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodward, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.