Organization
ELITE PEDS OK LLC
Active
Other names
Elite Pediatric Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS LANGSTON OTR (OWNER)
(918) 766-5233
Entity
Organization
Contact information
Practice address
4800 W SAN ANTONIO ST # 101, BROKEN ARROW, OK 74012-6127
(918) 417-8740
Mailing address
6385 E 124TH CT S, BIXBY, OK 74008-5894
(918) 417-8740
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201125410
—
OK
Enumeration date
12/08/2022
Last updated
08/02/2024
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