Healthcare Provider Details

I. General information

NPI: 1386942266
Provider Name (Legal Business Name): PTMS 3.0, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S MAIN ST
ELK CITY OK
73644-9166
US

IV. Provider business mailing address

2103 S MAIN ST
ELK CITY OK
73644-9166
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-0075
  • Fax: 580-225-0095
Mailing address:
  • Phone: 580-225-0075
  • Fax: 580-225-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3785
License Number StateOK

VIII. Authorized Official

Name: BRIDGIT FINLEY
Title or Position: MANAGER
Credential:
Phone: 405-809-8709