Healthcare Provider Details

I. General information

NPI: 1245162981
Provider Name (Legal Business Name): CARLENE TONEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 S LEE ST
FORT GIBSON OK
74434-8757
US

IV. Provider business mailing address

1207 S LEE ST
FORT GIBSON OK
74434-8757
US

V. Phone/Fax

Practice location:
  • Phone: 918-203-5001
  • Fax:
Mailing address:
  • Phone: 918-203-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4046
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: