MEDICARE: ORTHOPEDIC SPINE & SPORTS PHYSICAL THERAPY PLLC

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	225100000X	Physical Therapist	4469	OK

General Provider Information

NPI Number	:	1316311293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SPINE & SPORTS PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	1700 S BROADWAY ST STE E
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5302
Country	:	US
Telephone Number	:	405-735-8777
Fax Number	:	405-735-8778

Provider Business Practice Location Address
First Line	:	1700 S BROADWAY ST STE E
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-5302
Country	:	US
Telephone Number	:	405-735-8777
Fax Number	:	405-735-8778

Authorized Official
Title or Position	:	CO-OWNER, PHYSICAL THERAPIST
Name	:	JEFFREY L FRAZIER
Credential	:	DPT, OCS
Telephone Number	:	405-735-8777

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	03/17/2026

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