Basic Information
| Provider Information | |||||||||
| NPI: | 1184001067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PTMS 3.0,LLC | ||||||||
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| OtherOrganizationName: | PHYSICAL THERAPY CENTRAL OF YUKON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098709 | ||||||||
| FaxNumber: | 4055736768 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 GARTH BROOKS BLVD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730993806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053503336 | ||||||||
| FaxNumber: | 4053503337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 06/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | FINLEY | ||||||||
| AuthorizedOfficialFirstName: | BRIDGIT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4058098709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.