Healthcare Provider Details

I. General information

NPI: 1326955675
Provider Name (Legal Business Name): MEDINAS THERAPEUTIC MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 W WILSHIRE BLVD
OKLAHOMA CITY OK
73116-4028
US

IV. Provider business mailing address

4320 PALISADE LN
OKLAHOMA CITY OK
73179-1640
US

V. Phone/Fax

Practice location:
  • Phone: 405-802-5291
  • Fax:
Mailing address:
  • Phone: 405-802-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY MEDINA
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 405-802-5292