Healthcare Provider Details

I. General information

NPI: 1619033420
Provider Name (Legal Business Name): ENID P T PROFESSIONALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W OWEN K GARRIOTT RD
ENID OK
73701-5619
US

IV. Provider business mailing address

PO BOX 6064
ENID OK
73702-6064
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-7896
  • Fax: 580-233-6699
Mailing address:
  • Phone: 580-237-7896
  • Fax: 580-233-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL M. SEELKE
Title or Position: CO-OWNER
Credential: R.P.T.
Phone: 580-237-7896