Provider Demographics
NPI:1669685590
Name:CROSSETT ORTHOPAEDIC PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:CROSSETT ORTHOPAEDIC PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CROSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-840-6727
Mailing Address - Street 1:4323 NW 63RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1547
Mailing Address - Country:US
Mailing Address - Phone:405-840-6727
Mailing Address - Fax:405-840-6787
Practice Address - Street 1:4323 NW 63RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1547
Practice Address - Country:US
Practice Address - Phone:405-840-6727
Practice Address - Fax:405-840-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty