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General NPI Number Information
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NPI Number | 1538709365
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Entity Type | Individual
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Provider Name | KRISTA L BRIGHT PTA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 1401 4TH ST
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City | PAWNEE
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State | OK
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Zip | 74058-5003
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Country | US
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Telephone | 918-762-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 3925 ROCKY RIDGE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-6830
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Country | US
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Telephone | 580-716-8025
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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 | 2641
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License Number State | OK
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