Healthcare Provider Details

I. General information

NPI: 1053656876
Provider Name (Legal Business Name): PHILLIP THOMAS STUDEBAKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E ROBINSON ST
NORMAN OK
73071-7420
US

IV. Provider business mailing address

131 CRYSTAL BND
NORMAN OK
73069-8603
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-2866
  • Fax:
Mailing address:
  • Phone: 918-313-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4614
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: