MEDICARE: PHYCILITY LLC

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

General Provider Information

NPI Number	:	1649140435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYCILITY LLC

Provider Business Mailing Address
First Line	:	11901 N MACARTHUR BLVD STE G2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1854
Country	:	US
Telephone Number	:	580-430-6511
Fax Number	:	405-896-8414

Provider Business Practice Location Address
First Line	:	11901 N MACARTHUR BLVD STE G2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1854
Country	:	US
Telephone Number	:	580-430-6511
Fax Number	:	405-896-8414

Authorized Official
Title or Position	:	OWNER
Name	:	GRAYSON STARBUCK
Credential	:
Telephone Number	:	580-430-6511

Provider Enumeration Date	:	11/07/2025
Last Update Date	:	11/07/2025

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