Provider Demographics
NPI:1497371322
Name:SPURLOCK, LEAH DIANE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:DIANE
Last Name:SPURLOCK
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 1:1201 NORWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9782
Mailing Address - Country:US
Mailing Address - Phone:580-393-1024
Mailing Address - Fax:
Practice Address - Street 1:429 W WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7745
Practice Address - Country:US
Practice Address - Phone:405-250-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5757261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy