Healthcare Provider Details

I. General information

NPI: 1932697711
Provider Name (Legal Business Name): FYZICAL 73120, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 N MAY AVE
OKLAHOMA CITY OK
73116-3201
US

IV. Provider business mailing address

PO BOX 720808
OKLAHOMA CITY OK
73172-0808
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-6330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5393
License Number StateOK

VIII. Authorized Official

Name: DR. LAUREN COLLIER LAUREN
Title or Position: OWNER, MANAGER
Credential: PT
Phone: 405-230-6330