Organization
HUMAN PERFORMANCE CENTER 7 PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE LYNN WALLS P.T. (OWNER/PHYSICAL THERAPIST)
(405) 808-0445
Entity
Organization
Contact information
Practice address
740 S MUSTANG RD, YUKON, OK 73099-6777
(405) 494-7070
Mailing address
740 S MUSTANG RD, YUKON, OK 73099-6777
(405) 494-7070
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2776
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKB0011
MEDICARE PTAN
OK
Enumeration date
01/25/2008
Last updated
09/03/2008
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