Basic Information
Provider Information
NPI: 1356719538
EntityType: 2
ReplacementNPI:  
OrganizationName: PTMS 3.0, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PHYSICAL THERAPY CENTRAL OF GUTHRIE, LLC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 440 MERCHANT DR
Address2:  
City: NORMAN
State: OK
PostalCode: 730696470
CountryCode: US
TelephoneNumber: 4058098710
FaxNumber: 4055736768
Practice Location
Address1: 108 W HARRISON AVE
Address2:  
City: GUTHRIE
State: OK
PostalCode: 730444727
CountryCode: US
TelephoneNumber: 4052939892
FaxNumber: 4052939894
Other Information
ProviderEnumerationDate: 09/04/2015
LastUpdateDate: 09/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FINLEY
AuthorizedOfficialFirstName: BRIDGIT
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 4058098709
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y193400000X SINGLE SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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