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General NPI Number Information
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NPI Number | 1417078668
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Entity Type | Organization
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Legal Business Name | CHICKASHA PHYSICAL THERAPY CLINIC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 626 W KANSAS AVE
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City | CHICKASHA
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State | OK
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Zip | 73018
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Country | US
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Telephone | 405-222-5030
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Fax | 405-222-5050
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Provider Business Mailing Address
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Address Line | 626 W KANSAS AVE
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City | CHICKASHA
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State | OK
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Zip | 73018
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Country | US
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Telephone | 405-222-5030
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Fax | 405-222-5050
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA HORN
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Credential | PT
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Telephone | 405-222-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 464
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 124
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 464
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License Number State | OK
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