Provider Demographics
NPI:1639741465
Name:ECKSTROM, GRACE CATHERINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CATHERINE
Last Name:ECKSTROM
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 1:800 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7241
Mailing Address - Country:US
Mailing Address - Phone:405-609-3667
Mailing Address - Fax:405-609-3697
Practice Address - Street 1:7005 SE 15TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5126
Practice Address - Country:US
Practice Address - Phone:405-610-3535
Practice Address - Fax:405-610-2484
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist