Provider Demographics
NPI:1841417821
Name:QUITORIANO, DAVID CRISOLOGO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CRISOLOGO
Last Name:QUITORIANO
Suffix:
Gender:M
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:RR 2 BOX 49
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-9601
Mailing Address - Country:US
Mailing Address - Phone:405-375-2343
Mailing Address - Fax:405-375-2343
Practice Address - Street 1:RR 2 BOX 49
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-9601
Practice Address - Country:US
Practice Address - Phone:405-375-2343
Practice Address - Fax:405-375-2343
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist