Provider Demographics
NPI:1730274739
Name:NORTHWEST PHYSICAL THERAPY CLINIC INC
Entity type:Organization
Organization Name:NORTHWEST PHYSICAL THERAPY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HANDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-949-0404
Mailing Address - Street 1:5400 N GRAND BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5692
Mailing Address - Country:US
Mailing Address - Phone:405-949-0404
Mailing Address - Fax:405-949-1705
Practice Address - Street 1:5400 N GRAND BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5692
Practice Address - Country:US
Practice Address - Phone:405-949-0404
Practice Address - Fax:405-949-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-10-10
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
OK245710601Medicare PIN