Provider Demographics
NPI:1477730158
Name:HUMAN PERFORMANCE CENTER 7 PC
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE CENTER 7 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-808-0445
Mailing Address - Street 1:740 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6777
Mailing Address - Country:US
Mailing Address - Phone:405-494-7070
Mailing Address - Fax:
Practice Address - Street 1:740 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6777
Practice Address - Country:US
Practice Address - Phone:405-494-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2776172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB0011OtherMEDICARE PTAN