Healthcare Provider Details

I. General information

NPI: 1124271887
Provider Name (Legal Business Name): ELGIN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 US HIGHWAY 277
ELGIN OK
73538
US

IV. Provider business mailing address

7602 US HIGHWAY 277
ELGIN OK
73538
US

V. Phone/Fax

Practice location:
  • Phone: 580-678-0447
  • Fax:
Mailing address:
  • Phone: 580-678-0447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2454
License Number StateOK

VIII. Authorized Official

Name: TRACIE LYNN KOEHLER
Title or Position: OWNER
Credential: PT
Phone: 580-678-0447