Healthcare Provider Details

I. General information

NPI: 1184281313
Provider Name (Legal Business Name): CASI K WYER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 N BRYANT AVE STE 400
EDMOND OK
73013-6473
US

IV. Provider business mailing address

201 KIMBERLY DR
EDMOND OK
73003-4522
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-6080
  • Fax:
Mailing address:
  • Phone: 580-383-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5626
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: