Organization
EXCEL THERAPY SPECIALISTS--OKC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANICE L WAGONER (BUSINESS OFFICE MANAGER)
(918) 259-1888
Entity
Organization
Contact information
Practice address
1742 S 4TH ST, CHICKASHA, OK 73018-5901
(405) 825-3617
(405) 825-3618
Mailing address
2234-B W HOUSTON, BROKEN ARROW, OK 74012-3519
(918) 259-1888
(918) 251-3725
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200620300A
—
OK
Enumeration date
11/05/2015
Last updated
06/30/2016
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