Provider Demographics
NPI:1659590628
Name:ANTHONY, LETITIA BUGJO (MPT)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:BUGJO
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:
Other - Last Name:BUGJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:1076 W CHANDLER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5223
Mailing Address - Country:US
Mailing Address - Phone:405-946-7300
Mailing Address - Fax:405-946-7306
Practice Address - Street 1:3327 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5627
Practice Address - Country:US
Practice Address - Phone:405-946-7300
Practice Address - Fax:405-946-7306
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPT2961OtherLICENSE NUMBER