Healthcare Provider Details

I. General information

NPI: 1295940203
Provider Name (Legal Business Name): AUDREY LYNN FLUITT P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N INDEPENDENCE AVE STE 100
OKLAHOMA CITY OK
73112-5556
US

IV. Provider business mailing address

RR 3 BOX 423A
WELLSTON OK
74881-9459
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4500
  • Fax:
Mailing address:
  • Phone: 405-258-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3114
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: