Healthcare Provider Details

I. General information

NPI: 1295260644
Provider Name (Legal Business Name): VALIR OUTPATIENT CLINIC #17 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 03/22/2020
Certification Date: 03/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-9537
  • Fax: 405-222-9566
Mailing address:
  • Phone: 405-609-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAVANAH PATT
Title or Position: VP
Credential:
Phone: 405-609-3600