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General NPI Number Information
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NPI Number | 1356092076
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Entity Type | Individual
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Provider Name | BEAU PROCTOR
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Gender | Male
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 519 NW 23RD ST STE 106
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-1509
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Country | US
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Telephone | 405-613-6170
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Fax |
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Provider Business Mailing Address
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Address Line | 6445 N STERLING DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-6804
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Country | US
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Telephone | 405-613-6170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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