MEDICARE: MS. ELIZABETH RUTHERFORD BEASLEY RPT

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	7	OK

General Provider Information

NPI Number	:	1881895936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH RUTHERFORD BEASLEY RPT

Provider Business Mailing Address
First Line	:	1701 NW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-3217
Country	:	US
Telephone Number	:	405-525-8116
Fax Number	:	405-466-3565

Provider Business Practice Location Address
First Line	:	1701 NW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-3217
Country	:	US
Telephone Number	:	405-525-8116
Fax Number	:	405-466-3565

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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