Healthcare Provider Details

I. General information

NPI: 1417641796
Provider Name (Legal Business Name): CITY WIDE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NW 13TH ST
OKLAHOMA CITY OK
73106-6827
US

IV. Provider business mailing address

PO BOX 3325
OKLAHOMA CITY OK
73101-3325
US

V. Phone/Fax

Practice location:
  • Phone: 405-206-2378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATTY HOSKINS
Title or Position: MANAGER
Credential:
Phone: 405-206-2378