NPIMap

Organization Active NPI

Blue Rock Health and Wellness LLC

  • Physical Therapy Clinic/Center
  • Marlow, OK
National Provider Identifier
1578046827
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BLUE ROCK HEALTH AND WELLNESS LLC
Practice address
103 W Main St
Marlow, OK 73055-2437
Phone
(580) 721-7100
Fax
(833) 210-5732
NPI assigned
Sep 12, 2018
Last updated
Aug 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Timothy CarrollNPI 1770600694
Title
Member
Phone
(580) 217-7100

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 NU Primary

Addresses

Primary practice location

103 W Main St
Marlow, OK 73055-2437

Mailing address

231 W Main St
Marlow, OK 73055-2439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181115000599 OK Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7618221375 Receives reassigned benefits from 12 practitioners
Practice locations: Marlow, OK
O20210223000216 OK Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7618221375 Practice locations: Marlow, OK

National Provider Directory

National Provider Directory

Locations

103 W Main St
Marlow, OK 73055
Phone (580) 658-2319

231 W Main St
Marlow, OK 73055
Phone (580) 658-2319

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1578046827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 W MAIN ST",
            "city": "MARLOW",
            "state": "OK",
            "postal_code": "730552439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W MAIN ST",
            "city": "MARLOW",
            "state": "OK",
            "postal_code": "730552437",
            "telephone_number": "580-721-7100",
            "fax_number": "833-210-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ROCK HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-12",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "CARROLL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "580-217-7100"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.