Basic Information
Provider Information
NPI: 1336679893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCGEHEE
FirstName: AUSTIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, DPT, CSCS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2488 E 81ST ST STE 290
Address2:  
City: TULSA
State: OK
PostalCode: 741374265
CountryCode: US
TelephoneNumber: 9189273226
FaxNumber: 9189273193
Practice Location
Address1: 2488 E 81ST ST STE 290
Address2:  
City: TULSA
State: OK
PostalCode: 741374265
CountryCode: US
TelephoneNumber: 9189273199
FaxNumber: 9189273201
Other Information
ProviderEnumerationDate: 06/18/2017
LastUpdateDate: 08/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X1292173TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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