Healthcare Provider Details

I. General information

NPI: 1881325488
Provider Name (Legal Business Name): LAURA BERGLAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14890 SE 29TH ST
CHOCTAW OK
73020-3515
US

IV. Provider business mailing address

14890 SE 29TH ST
CHOCTAW OK
73020-3515
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-1731
  • Fax:
Mailing address:
  • Phone: 405-390-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3577
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: