Healthcare Provider Details

I. General information

NPI: 1447627062
Provider Name (Legal Business Name): SITTICHOTI BUNNAG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 24TH AVE NW SUITE 100
NORMAN OK
73069-6232
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-321-5969
  • Fax: 405-321-5967
Mailing address:
  • Phone: 405-609-1122
  • Fax: 800-506-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2151
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: