MEDICARE: WANDA PC ADKINS PHYSICAL THERAPIST

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	225100000X	Physical Therapist	0105001896	VA

General Provider Information

NPI Number	:	1548296742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA PC ADKINS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	5700 ARNOLD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73145-8105
Country	:	US
Telephone Number	:	405-736-2206
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARNOLD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73145-8105
Country	:	US
Telephone Number	:	405-736-2206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	09/14/2007

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