=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255034476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAPTABLE PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2023
-----------------------------------------------------
Last Update Date | 03/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 E 3RD ST
-----------------------------------------------------
City | GROVE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74344-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-791-8789
-----------------------------------------------------
Fax | 877-912-0432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 E 3RD ST
-----------------------------------------------------
City | GROVE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74344-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-791-8789
-----------------------------------------------------
Fax | 877-912-0432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PT
-----------------------------------------------------
Name | DR. SAMANTHA LYNN CHAMBERLAIN
-----------------------------------------------------
Credential | PT, DPT, CERT- MMOA
-----------------------------------------------------
Telephone | 918-791-8789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------