| Boomer 06, Pllc | |
|
10921 S Western Ave Ste 200, Oklahoma City, OK 73170-6228 | |
| (405) 996-0660 | |
| Not Available |
| Full Name | Boomer 06, Pllc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 10921 S Western Ave Ste 200, Oklahoma City, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871126383 | NPI | - | NPPES |
| 200934220A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Ryan Edward Elassal |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1417587676 PECOS PAC ID: 8224469176 Enrollment ID: I20200511001258 |
| Provider Name | Michael Steven Hayes |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164824017 PECOS PAC ID: 3577785161 Enrollment ID: I20200511001391 |
| Provider Name | Josie Cocannouer Blackburn |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1306201348 PECOS PAC ID: 8921410838 Enrollment ID: I20201217003072 |
| Provider Name | Trent Bradley Harvick |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881045318 PECOS PAC ID: 3476922915 Enrollment ID: I20221206000942 |
| Mailing Address | Practice Location Address |
|---|---|
| Boomer 06, Pllc 10921 S Western Ave Ste 200, Oklahoma City, OK 73170-6228 Ph: (405) 676-5606 | Boomer 06, Pllc 10921 S Western Ave Ste 200, Oklahoma City, OK 73170-6228 Ph: (405) 996-0660 |
Tressie Mccoy, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 700 Ne 13th St, Oklahoma City, OK 73104 Phone: 405-271-8000 | |
Prof. Martha J Ferretti, PT, MPH, FAPTA Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 801 Ne 13th St, Room 237a, Oklahoma City, OK 73104 Phone: 405-271-2434 Fax: 405-271-2432 | |
Jessica R. Swanson, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 9600 Broadway Ext, Oklahoma City, OK 73114 Phone: 405-230-9000 | |
Dr. Temitope Gabriel Olaniwun, PT,DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 3030 Nw Expressway, Suite 809, Oklahoma City, OK 73112 Phone: 866-848-8813 Fax: 866-848-8814 | |
Tyler Hamilton, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1407 N Robinson Ave, Oklahoma City, OK 73103 Phone: 404-232-8000 | |
Don Van Nguyen, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 923 N Robinson Ave, Oklahoma City, OK 73102 Phone: 405-231-5800 | |
Mitchell Cameron Stroud, PT,DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 10325 Greenbriar Pl Ste B, Oklahoma City, OK 73159 Phone: 405-759-7719 |