Provider Demographics
NPI:1609254101
Name:MARKWARDT, SLOANE (PTA)
Entity Type:Individual
Prefix:
First Name:SLOANE
Middle Name:
Last Name:MARKWARDT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SW 122ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4859
Mailing Address - Country:US
Mailing Address - Phone:405-692-2366
Mailing Address - Fax:717-635-3682
Practice Address - Street 1:1634 SW 122ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4859
Practice Address - Country:US
Practice Address - Phone:405-692-2366
Practice Address - Fax:717-635-3682
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2159225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant