Provider Demographics
NPI:1801861711
Name:SIEGENTHALER, L MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:MICHAEL
Last Name:SIEGENTHALER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:MICHAEL
Other - Last Name:SIEGENTHALER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:813 E 6TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-4701
Mailing Address - Country:US
Mailing Address - Phone:918-756-3330
Mailing Address - Fax:918-756-3332
Practice Address - Street 1:813 E 6TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4701
Practice Address - Country:US
Practice Address - Phone:918-756-3330
Practice Address - Fax:918-756-3332
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100833730AMedicaid