Provider Demographics
NPI:1326605536
Name:MCINTYRE, WILLIAM GRAHAM (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRAHAM
Last Name:MCINTYRE
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 1:714 E BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4315
Mailing Address - Country:US
Mailing Address - Phone:918-230-1196
Mailing Address - Fax:
Practice Address - Street 1:714 E BEAVER ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4315
Practice Address - Country:US
Practice Address - Phone:918-230-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5537225100000X
FL33745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist