Organization
PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUDRIA JEAN MARIE BAXTER PTA (OWNER)
(918) 649-0799
Entity
Organization
Contact information
Practice address
1932 N BROADWAY, POTEAU, OK 74953
(918) 649-0799
(918) 649-0797
Mailing address
1932 N BROADWAY, POTEAU, OK 74953
(918) 649-0799
(918) 649-0797
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200006850A
—
OK
01
—
DD4017
RR MEDICARE
OK
Enumeration date
05/10/2006
Last updated
02/10/2012
Update your record
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