Healthcare Provider Details

I. General information

NPI: 1700083912
Provider Name (Legal Business Name): DARRELL SMITH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NW 6TH ST STE 104
OKLAHOMA CITY OK
73102-6089
US

IV. Provider business mailing address

7908 WOOD DUCK DR
OKLAHOMA CITY OK
73132-3331
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-0700
  • Fax: 405-272-0701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0083168
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3639
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: