Healthcare Provider Details

I. General information

NPI: 1134711229
Provider Name (Legal Business Name): LYNETTE HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 11/27/2024
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S. DOUGLAS BLVD #306
OKLAHOMA CITY OK
73150
US

IV. Provider business mailing address

9060 HARMONY DRIVE SUITE A
MIDWEST CITY OK
73130
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-0010
  • Fax:
Mailing address:
  • Phone: 405-454-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2041
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: