Provider Demographics
NPI:1538297759
Name:AFFILIATED PHYSICAL THERAPISTS, INC.
Entity Type:Organization
Organization Name:AFFILIATED PHYSICAL THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LUCHT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-340-0770
Mailing Address - Street 1:1225 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5708
Mailing Address - Country:US
Mailing Address - Phone:405-340-0770
Mailing Address - Fax:405-330-5302
Practice Address - Street 1:1225 E 9TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5708
Practice Address - Country:US
Practice Address - Phone:405-340-0770
Practice Address - Fax:405-330-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK500522017Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER