Provider Demographics
NPI:1144841891
Name:FULL MOTION PHYSICAL THERAPY
Entity type:Organization
Organization Name:FULL MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:405-614-1390
Mailing Address - Street 1:6211 PEARL SNAP TRL
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-7457
Mailing Address - Country:US
Mailing Address - Phone:405-614-1390
Mailing Address - Fax:
Practice Address - Street 1:6211 PEARL SNAP TRL
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-7457
Practice Address - Country:US
Practice Address - Phone:405-614-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health