Provider Demographics
NPI:1477751253
Name:CHITWOOD PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:CHITWOOD PHYSICAL THERAPY PLLC
Other - Org Name:ELITE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:918-649-0405
Mailing Address - Street 1:38271 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-2707
Mailing Address - Country:US
Mailing Address - Phone:817-649-0405
Mailing Address - Fax:918-647-0403
Practice Address - Street 1:24456 KERR RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953
Practice Address - Country:US
Practice Address - Phone:918-649-0405
Practice Address - Fax:918-647-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3661261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK46048007OtherHEALTHCHOICE