Healthcare Provider Details

I. General information

NPI: 1972145886
Provider Name (Legal Business Name): CRYSTOPHER J LONG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARKWAY POST ACUTE RECOVERY CENTER 6312 N PORTLAND
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

2035 E IRON AVE STE 224
SALINA KS
67401-3433
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-0700
  • Fax:
Mailing address:
  • Phone: 785-407-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3642
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: