Healthcare Provider Details

I. General information

NPI: 1831587088
Provider Name (Legal Business Name): WEATHERFORD HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 LEGACY
WEATHERFORD OK
73096-9746
US

IV. Provider business mailing address

3701 E MAIN ST
WEATHERFORD OK
73096-3309
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-2604
  • Fax: 580-772-2906
Mailing address:
  • Phone: 580-772-5551
  • Fax: 580-774-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2264
License Number StateOK

VIII. Authorized Official

Name: DEBRA K HOWE
Title or Position: CEO
Credential:
Phone: 580-772-5551