Healthcare Provider Details

I. General information

NPI: 1760067045
Provider Name (Legal Business Name): CHRISTIAN HALE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E 3RD ST
GROVE OK
74344-7034
US

IV. Provider business mailing address

PO BOX 1521
JAY OK
74346-1521
US

V. Phone/Fax

Practice location:
  • Phone: 918-791-8789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6639
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2426
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: