Provider Demographics
NPI:1619033420
Name:ENID P T PROFESSIONALS INC
Entity type:Organization
Organization Name:ENID P T PROFESSIONALS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEELKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:580-237-7896
Mailing Address - Street 1:PO BOX 6064
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-6064
Mailing Address - Country:US
Mailing Address - Phone:580-237-7896
Mailing Address - Fax:580-233-6699
Practice Address - Street 1:225 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5619
Practice Address - Country:US
Practice Address - Phone:580-237-7896
Practice Address - Fax:580-233-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK376547Medicare ID - Type Unspecified