Provider Demographics
NPI:1083882732
Name:WILLMAN, CHRISTY L (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:WILLMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3529
Mailing Address - Country:US
Mailing Address - Phone:918-259-9522
Mailing Address - Fax:918-259-9521
Practice Address - Street 1:1004 N 19TH AVE
Practice Address - Street 2:BLDG #4
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3016
Practice Address - Country:US
Practice Address - Phone:580-931-3300
Practice Address - Fax:580-931-3301
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200131840AMedicaid
OK200131840AMedicaid