Provider Demographics
NPI:1396396131
Name:NIDA, HALEY PATZ (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:HALEY
Middle Name:PATZ
Last Name:NIDA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2344
Mailing Address - Country:US
Mailing Address - Phone:580-430-8022
Mailing Address - Fax:
Practice Address - Street 1:520 FLYNN ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2240
Practice Address - Country:US
Practice Address - Phone:580-327-3331
Practice Address - Fax:580-327-3314
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist