Provider Demographics
NPI:1659912673
Name:MIND BODY & SOUL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MIND BODY & SOUL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:918-577-5088
Mailing Address - Street 1:1400 E OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5644
Mailing Address - Country:US
Mailing Address - Phone:918-577-5088
Mailing Address - Fax:
Practice Address - Street 1:1400 E OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5644
Practice Address - Country:US
Practice Address - Phone:918-577-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty