MEDICARE: THERESA MICHELLE NEWBOLD PT

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	2305209928	VA

General Provider Information

NPI Number	:	1669868386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MICHELLE NEWBOLD PT

Provider Business Mailing Address
First Line	:	7919 MID AMERICA BLVD STE 240
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6618
Country	:	US
Telephone Number	:	405-400-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	7919 MID AMERICA BLVD STE 240
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6618
Country	:	US
Telephone Number	:	405-400-2273
Fax Number	:	405-870-1400

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

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	11/17/2025

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