Basic Information
| Provider Information | |||||||||
| NPI: | 1306278080 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PTMS 3.0, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHYSICAL THERAPY CENTRAL OF BLANCHARD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 837 E VETERANS MEMORIAL HWY | ||||||||
| Address2: | |||||||||
| City: | BLANCHARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730109215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098705 | ||||||||
| FaxNumber: | 4054854500 | ||||||||
| Practice Location | |||||||||
| Address1: | 837 E VETERANS MEMORIAL HWY | ||||||||
| Address2: | |||||||||
| City: | BLANCHARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730109215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098705 | ||||||||
| FaxNumber: | 4054854500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2013 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | FINLEY | ||||||||
| AuthorizedOfficialFirstName: | BRIDGIT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4058098709 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3557 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.