Healthcare Provider Details

I. General information

NPI: 1033514161
Provider Name (Legal Business Name): COLBY HELFFRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
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

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-0075
  • Fax: 580-225-0095
Mailing address:
  • Phone: 405-809-8710
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4892
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: