Healthcare Provider Details

I. General information

NPI: 1861044521
Provider Name (Legal Business Name): STEP BY STEP THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 N GARNETT RD STE B
OWASSO OK
74055-4243
US

IV. Provider business mailing address

PO BOX 1138
OWASSO OK
74055-1138
US

V. Phone/Fax

Practice location:
  • Phone: 918-553-1122
  • Fax: 833-840-6360
Mailing address:
  • Phone: 918-553-1122
  • Fax: 833-840-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MYNDA MISER
Title or Position: PHYSICAL THERAPIST/ OWNER
Credential: PT
Phone: 918-533-1122