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General NPI Number Information
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NPI Number | 1538895875
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Entity Type | Organization
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Legal Business Name | LETS GROW PEDIATRICS LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 15121 TRADITIONS BLVD
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 918-855-8844
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Fax |
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Provider Business Mailing Address
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Address Line | 15121 TRADITIONS BLVD
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPT., OWNER, AUTHORIZED OFFICIAL
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Name | ABBY LAYNE JONES
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Credential | DPT, PCS
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Telephone | 918-855-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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