MEDICARE: CHRISTOPHER VALDOZ DE LEON PT

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	3147	OK

General Provider Information

NPI Number	:	1750581336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER VALDOZ DE LEON PT

Provider Business Mailing Address
First Line	:	1900 LONA AVE
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-2053
Country	:	US
Telephone Number	:	405-343-2391
Fax Number	:	405-382-5433

Provider Business Practice Location Address
First Line	:	1900 LONA AVE
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-2053
Country	:	US
Telephone Number	:	405-343-2391
Fax Number	:	405-382-5433

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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