Healthcare Provider Details

I. General information

NPI: 1285475814
Provider Name (Legal Business Name): MAKAYLA WHITE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 NW 39TH EXPY FL 3
BETHANY OK
73008-2868
US

IV. Provider business mailing address

2708 MUSTANG TRL
EDMOND OK
73012-6673
US

V. Phone/Fax

Practice location:
  • Phone: 405-981-4001
  • Fax:
Mailing address:
  • Phone: 405-315-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6516
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: