Healthcare Provider Details

I. General information

NPI: 1700637402
Provider Name (Legal Business Name): PHYSICAL SOLUTIONS YUKON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST STE 125
YUKON OK
73099-2171
US

IV. Provider business mailing address

815 E MAIN ST STE 125
YUKON OK
73099-2171
US

V. Phone/Fax

Practice location:
  • Phone: 405-467-4759
  • Fax:
Mailing address:
  • Phone: 405-467-4759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DESIREE KOENIG
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-726-2727