Healthcare Provider Details

I. General information

NPI: 1053069591
Provider Name (Legal Business Name): BEYOND PT SOUTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 S SHERIDAN RD STE C
TULSA OK
74133-6731
US

IV. Provider business mailing address

10106 S SHERIDAN RD STE C
TULSA OK
74133-6776
US

V. Phone/Fax

Practice location:
  • Phone: 918-695-1485
  • Fax: 918-280-0170
Mailing address:
  • Phone: 918-995-2500
  • Fax: 918-995-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLIE ERIN HOWERTON
Title or Position: OWNER/MANAGER
Credential: PT, DPT
Phone: 918-995-2500