Healthcare Provider Details

I. General information

NPI: 1447728613
Provider Name (Legal Business Name): JAMIE LYNN STEIDLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE STE 310
TULSA OK
74136-8334
US

IV. Provider business mailing address

2488 E 81ST ST STE 290
TULSA OK
74137-4265
US

V. Phone/Fax

Practice location:
  • Phone: 918-502-4700
  • Fax: 918-502-4701
Mailing address:
  • Phone: 918-494-9341
  • Fax: 918-494-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1672
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: