Healthcare Provider Details

I. General information

NPI: 1225527997
Provider Name (Legal Business Name): KYLE CULVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 SOUTH SHERIDAN ROAD
TULSA OK
74133
US

IV. Provider business mailing address

10123 S SHERIDAN RD
TULSA OK
74133-6732
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-3991
  • Fax:
Mailing address:
  • Phone: 205-259-3991
  • Fax: 205-876-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: