Provider Demographics
NPI:1659830156
Name:ASCENT PHYSICAL THERAPY AND PERFORMANCE LLC
Entity type:Organization
Organization Name:ASCENT PHYSICAL THERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:918-822-7028
Mailing Address - Street 1:16325 N MAY AVE STE A4
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9142
Mailing Address - Country:US
Mailing Address - Phone:918-822-7028
Mailing Address - Fax:
Practice Address - Street 1:16325 N MAY AVE STE A4
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-9142
Practice Address - Country:US
Practice Address - Phone:918-822-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1649689241OtherNPI