Provider Demographics
NPI:1891716296
Name:FLANARY, MIKE S (PT)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:S
Last Name:FLANARY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 W HOUSTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3519
Mailing Address - Country:US
Mailing Address - Phone:918-259-1888
Mailing Address - Fax:918-251-3725
Practice Address - Street 1:2232 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3529
Practice Address - Country:US
Practice Address - Phone:918-259-9522
Practice Address - Fax:918-259-9521
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200092750AMedicaid
OK200092750AMedicaid