Healthcare Provider Details

I. General information

NPI: 1982116109
Provider Name (Legal Business Name): STEPHANIE CHRISTINE MESTRE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

IV. Provider business mailing address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

V. Phone/Fax

Practice location:
  • Phone: 405-470-2242
  • Fax: 405-438-3834
Mailing address:
  • Phone: 405-470-2238
  • Fax: 405-440-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5402
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: