Healthcare Provider Details

I. General information

NPI: 1548205396
Provider Name (Legal Business Name): AMY MELISSA PRITCHARD MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 W MEMORIAL RD
OKLAHOMA CITY OK
73134-7015
US

IV. Provider business mailing address

832 FOX RIDGE DR
EDMOND OK
73034-7346
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-7950
  • Fax: 405-749-7940
Mailing address:
  • Phone: 405-623-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3810
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: