Basic Information
| Provider Information | |||||||||
| NPI: | 1245431667 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICAL THERAPY SOLUTIONS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 SW 38TH ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735057013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803519956 | ||||||||
| FaxNumber: | 5803519395 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 SW 38TH ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735057013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803519956 | ||||||||
| FaxNumber: | 5803519395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLURE | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5803519956 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2557 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1306804570 | 01 | OK | IND NPI NUMBER | OTHER |