Basic Information
| Provider Information | |||||||||
| NPI: | 1053069591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEYOND PT SOUTH PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6037 E 147TH ST S | ||||||||
| Address2: | |||||||||
| City: | BIXBY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740083983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189544136 | ||||||||
| FaxNumber: | 9182800170 | ||||||||
| Practice Location | |||||||||
| Address1: | 10106 S SHERIDAN RD STE C | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741336731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186951485 | ||||||||
| FaxNumber: | 9182800170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2022 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOWERTON | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9186951485 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.