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General NPI Number Information
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NPI Number | 1497524029
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Entity Type | Individual
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Provider Name | KORDD STANDIFER
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Gender | Male
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 2309 N MILT PHILLIPS AVE STE B
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City | SEMINOLE
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State | OK
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Zip | 74868-2328
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Country | US
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Telephone | 405-303-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1980
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3738
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License Number State | OK
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