Healthcare Provider Details

I. General information

NPI: 1922775378
Provider Name (Legal Business Name): CHRISTY KECK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S 129TH EAST AVE STE 116
TULSA OK
74134-5809
US

IV. Provider business mailing address

4500 S 129TH EAST AVE STE 116
TULSA OK
74134-5809
US

V. Phone/Fax

Practice location:
  • Phone: 918-249-0877
  • Fax:
Mailing address:
  • Phone: 918-249-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: