Organization
FUNDAMENTAL PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA SUE CLARK DPT (OWNER)
(405) 513-8118
Entity
Organization
Contact information
Practice address
3500 S BOULEVARD, SUITE A1, EDMOND, OK 73013-5486
(405) 518-8118
Mailing address
PO BOX 3542, EDMOND, OK 73083-3542
(405) 513-8118
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
821
OK
Other
Enumeration date
12/15/2009
Last updated
09/01/2015
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