Healthcare Provider Details

I. General information

NPI: 1861416430
Provider Name (Legal Business Name): MID-DEL PHYSICAL THERAPY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 EPPERLY DR
DEL CITY OK
73115-3319
US

IV. Provider business mailing address

PO BOX 15171
DEL CITY OK
73155-5171
US

V. Phone/Fax

Practice location:
  • Phone: 405-209-4560
  • Fax:
Mailing address:
  • Phone: 405-209-4560
  • 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: SHERI DANELL SILVER
Title or Position: CORPORATE SECRETARY
Credential: P.T.
Phone: 405-209-4560