Healthcare Provider Details

I. General information

NPI: 1386338978
Provider Name (Legal Business Name): AMANDA MARIE KOURI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W HEFNER RD STE D
OKLAHOMA CITY OK
73120-5060
US

IV. Provider business mailing address

3333 W HEFNER RD STE D
OKLAHOMA CITY OK
73120-5060
US

V. Phone/Fax

Practice location:
  • Phone: 405-849-9205
  • Fax: 405-400-8788
Mailing address:
  • Phone: 405-849-9205
  • Fax: 405-400-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6318
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: