Provider Demographics
NPI:1891587143
Name:VINCENT, LILY ELEANOR RUTH (DPT)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:ELEANOR RUTH
Last Name:VINCENT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-8824
Mailing Address - Country:US
Mailing Address - Phone:918-619-4600
Mailing Address - Fax:918-619-4662
Practice Address - Street 1:1111 S SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5440
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4662
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist