Healthcare Provider Details

I. General information

NPI: 1770273922
Provider Name (Legal Business Name): WILLIAM BRET KLINE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 W GORE BLVD
LAWTON OK
73505-5998
US

IV. Provider business mailing address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-6785
  • Fax:
Mailing address:
  • Phone: 405-553-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5947
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: