Healthcare Provider Details

I. General information

NPI: 1033466305
Provider Name (Legal Business Name): JUDY HOWARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 GOLD FIELDS TRL
EDMOND OK
73003-2078
US

IV. Provider business mailing address

429 GOLD FIELDS TRL
EDMOND OK
73003-2078
US

V. Phone/Fax

Practice location:
  • Phone: 509-859-4177
  • Fax:
Mailing address:
  • Phone: 509-859-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1032
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: