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General NPI Number Information
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NPI Number | 1952139388
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Entity Type | Organization
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Legal Business Name | BESPOKE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 4907 E GALVESTON PL
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City | BROKEN ARROW
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State | OK
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Zip | 74014-2342
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Country | US
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Telephone | 918-841-6257
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Fax | 539-399-7520
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Provider Business Mailing Address
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Address Line | 4907 E GALVESTON PL
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City | BROKEN ARROW
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State | OK
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Zip | 74014-2342
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Country | US
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Telephone | 918-841-6257
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Fax | 539-399-7520
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Authorized Official
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Title or Position | OWNER
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Name | NIKOLAUS PRESCOTT
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Credential | PT, DPT
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Telephone | 918-841-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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