MEDICARE: SANDI NATTHAKARN ATTAMAKULSRI KOSITCHAIWAT 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	208100000X	Physical Medicine & Rehabilitation Physician	1437110020	OK
2	225200000X	Physical Therapy Assistant	3733	OK

General Provider Information

NPI Number	:	1801578992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDI NATTHAKARN ATTAMAKULSRI KOSITCHAIWAT PTA

Provider Business Mailing Address
First Line	:	2606 N PENIEL ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-1424
Country	:	US
Telephone Number	:	405-642-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 NW 39TH EXPY
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-2868
Country	:	US
Telephone Number	:	405-981-4001
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	12/17/2025

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