Healthcare Provider Details

I. General information

NPI: 1992989891
Provider Name (Legal Business Name): MS. LINDA C THORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 S HARVARD AVE STE 101C
TULSA OK
74135-2942
US

IV. Provider business mailing address

1603 N LEWIS PL
TULSA OK
74110-2548
US

V. Phone/Fax

Practice location:
  • Phone: 303-619-6564
  • Fax:
Mailing address:
  • Phone: 303-619-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT0005643
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: