Basic Information
| Provider Information | |||||||||
| NPI: | 1952981169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PTC OF ARDMORE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 MERCHANT DR | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058098709 | ||||||||
| FaxNumber: | 4055736868 | ||||||||
| Practice Location | |||||||||
| Address1: | 2015 W BROADWAY ST UNIT A | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734012558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802471320 | ||||||||
| FaxNumber: | 5802471319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2021 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | FINLEY | ||||||||
| AuthorizedOfficialFirstName: | BRIDGIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4058098709 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
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.