Provider Demographics
NPI:1457002362
Name:OAK PHYSICAL THERAPY & WELLNESS PC
Entity Type:Organization
Organization Name:OAK PHYSICAL THERAPY & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:OAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:805-458-8751
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-1295
Mailing Address - Country:US
Mailing Address - Phone:805-458-8751
Mailing Address - Fax:212-596-7133
Practice Address - Street 1:4425 BERRY DR # 3711
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9102
Practice Address - Country:US
Practice Address - Phone:805-458-8751
Practice Address - Fax:212-596-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty