Provider Demographics
NPI:1245617257
Name:WASHBURN, BOBBI (MPT)
Entity Type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 RED OAK CIR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-6295
Mailing Address - Country:US
Mailing Address - Phone:918-671-6804
Mailing Address - Fax:918-553-6552
Practice Address - Street 1:1414 S DENVER AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-3423
Practice Address - Country:US
Practice Address - Phone:918-712-7805
Practice Address - Fax:918-712-7813
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist