Healthcare Provider Details

I. General information

NPI: 1578995908
Provider Name (Legal Business Name): ADRIAN GHEORGHE BUTUC LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 S MINGO #B
TULSA OK
74146
US

IV. Provider business mailing address

5635 S MINGO #B
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-406-7474
  • Fax:
Mailing address:
  • Phone: 918-406-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number1033695
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1033695
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1033695
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: