MEDICARE: ORTHOPEDIC PHYSICAL THERAPY SPECIALISTS, PLLC

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	2251X0800X	Orthopedic Physical Therapist	2783	OK

General Provider Information

NPI Number	:	1952623464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC PHYSICAL THERAPY SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	3345 S HARVARD AVE
Second Line	:	SUITE 101
City	:	TULSA
State	:	OK
Zip	:	74135-1812
Country	:	US
Telephone Number	:	918-743-3737
Fax Number	:	918-743-8833

Provider Business Practice Location Address
First Line	:	3345 S HARVARD AVE
Second Line	:	SUITE 101
City	:	TULSA
State	:	OK
Zip	:	74135-1812
Country	:	US
Telephone Number	:	918-743-3737
Fax Number	:	918-743-8833

Authorized Official
Title or Position	:	PT/OWNER
Name	:	MR. RYAN M SMITH
Credential	:	PT
Telephone Number	:	918-743-3737

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	03/09/2010

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