MEDICARE: AZHAR THERAPY & FITNESS, INC

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	174400000X	Specialist	PT2109	OK

General Provider Information

NPI Number	:	1851434211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZHAR THERAPY & FITNESS, INC

Provider Business Mailing Address
First Line	:	3410 NW 135TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4009
Country	:	US
Telephone Number	:	405-752-7377
Fax Number	:	405-752-7387

Provider Business Practice Location Address
First Line	:	3410 NW 135TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4009
Country	:	US
Telephone Number	:	405-752-7377
Fax Number	:	405-752-7387

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LISA ANN AZHAR
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	405-752-7377

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	06/18/2015

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