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NPI Code Detail

MEDICARE: DR. LOUIS VINCE LEPAK III D.P.T.

MEDICARE: DR. LOUIS VINCE LEPAK III D.P.T.
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
1225100000XPhysical TherapistPT1581OK

General Provider Information

NPI Number : 1568519072
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOUIS VINCE LEPAK III D.P.T.
Provider Business Mailing Address
First Line : 11523 S MULBERRY CT
Second Line :
City : JENKS
State : OK
Zip : 74037-3462
Country : US
Telephone Number : 918-299-2542
Fax Number :
Provider Business Practice Location Address
First Line : 4502 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-2536
Country : US
Telephone Number : 918-660-3275
Fax Number : 918-660-3297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 03/14/2013

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