MEDICARE: CARISSA CHURCHILL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3369	OK

General Provider Information

NPI Number	:	1033787478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA CHURCHILL PTA

Provider Business Mailing Address
First Line	:	6613 N HARVARD AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-6946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 NW EXPRESSWAY STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-3509
Country	:	US
Telephone Number	:	405-722-2868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2021
Last Update Date	:	11/19/2025

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Directions to “ CARISSA CHURCHILL PTA” Practice Location

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