Provider Demographics
NPI:1073809349
Name:CORDES, LEVI WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:WILLIAM
Last Name:CORDES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3675
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:1907 S GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-6203
Practice Address - Country:US
Practice Address - Phone:405-527-3524
Practice Address - Fax:405-527-3536
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200340070AMedicaid
OKOKAAA1368Medicare PIN