Healthcare Provider Details

I. General information

NPI: 1285270371
Provider Name (Legal Business Name): CARRIE LINN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 COUNTY ROAD 1290
VERDEN OK
73092-8301
US

IV. Provider business mailing address

180 COUNTY ROAD 1290
VERDEN OK
73092-8301
US

V. Phone/Fax

Practice location:
  • Phone: 405-426-9218
  • Fax:
Mailing address:
  • Phone: 405-426-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1572
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: