MEDICARE: MUV OKC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist

General Provider Information

NPI Number	:	1073189635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUV OKC, LLC

Provider Business Mailing Address
First Line	:	1213 SW 18TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-7217
Country	:	US
Telephone Number	:	405-633-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N BROADWAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-4609
Country	:	US
Telephone Number	:	405-633-0193
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE WOMACK
Credential	:	PT, DPT
Telephone Number	:	405-633-0193

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	04/30/2024

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Directions to “MUV OKC, LLC ” Practice Location

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