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1337 E State Highway 152, Suite 111, Mustang, OK 73064-5108 | |
(405) 888-5434 | |
(405) 888-5451 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 1337 E State Highway 152, Mustang, Oklahoma |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1447332077 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Cody R Payne |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1053501437 PECOS PAC ID: 0749346484 Enrollment ID: I20090305000150 |
Provider Name | John R Reneau |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1174553317 PECOS PAC ID: 5193800290 Enrollment ID: I20170509002490 |
Mailing Address | Practice Location Address |
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Po Box 932184, Atlanta, GA 31193-2184 Ph: () - | 1337 E State Highway 152, Suite 111, Mustang, OK 73064-5108 Ph: (405) 888-5434 |