Provider Demographics
NPI:1043512064
Name:MCILROY, TERESA JO (RPT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JO
Last Name:MCILROY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:224 W DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-2351
Mailing Address - Country:US
Mailing Address - Phone:918-266-0427
Mailing Address - Fax:918-266-0428
Practice Address - Street 1:8937 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6004
Practice Address - Country:US
Practice Address - Phone:918-615-3722
Practice Address - Fax:918-615-3723
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist