Provider Demographics
NPI:1851434211
Name:AZHAR THERAPY & FITNESS, INC
Entity Type:Organization
Organization Name:AZHAR THERAPY & FITNESS, INC
Other - Org Name:THERAPY & FITNESS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:405-752-7377
Mailing Address - Street 1:3410 NW 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4009
Mailing Address - Country:US
Mailing Address - Phone:405-752-7377
Mailing Address - Fax:405-752-7387
Practice Address - Street 1:3410 NW 135TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4009
Practice Address - Country:US
Practice Address - Phone:405-752-7377
Practice Address - Fax:405-752-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK347609827Medicare ID - Type Unspecified