Healthcare Provider Details

I. General information

NPI: 1699680991
Provider Name (Legal Business Name): X-ZACT THERAPY & AQUATICS OF HUGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S BROADWAY ST
HUGO OK
74743-4417
US

IV. Provider business mailing address

121 S BROADWAY ST
HUGO OK
74743-4417
US

V. Phone/Fax

Practice location:
  • Phone: 580-505-2655
  • Fax:
Mailing address:
  • Phone: 580-505-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HUTOKSHI PARDIWLLA
Title or Position: CREDENTIALING CORDINATOR
Credential:
Phone: 903-782-9922