Healthcare Provider Details

I. General information

NPI: 1003876889
Provider Name (Legal Business Name): SIDONIE R BEVIER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 36TH AVE NW
NORMAN OK
73072-1803
US

IV. Provider business mailing address

9600 BROADWAY EXT
OKLAHOMA CITY OK
73114-7408
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9675
  • Fax: 405-230-9680
Mailing address:
  • Phone: 405-230-9000
  • Fax: 405-230-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2036
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2036
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: