Healthcare Provider Details

I. General information

NPI: 1568671915
Provider Name (Legal Business Name): JANET LEE ESKRIDGE RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 BLUE JAY CT
EDMOND OK
73034-6105
US

IV. Provider business mailing address

1909 BLUEJAY COURT
EDMOND OK
73034
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-4692
  • Fax:
Mailing address:
  • Phone: 405-341-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1105
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: