Provider Demographics
NPI:1902819253
Name:GEORGE, AUDRA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6039
Mailing Address - Country:US
Mailing Address - Phone:405-609-3675
Mailing Address - Fax:405-605-8638
Practice Address - Street 1:8409 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9211
Practice Address - Country:US
Practice Address - Phone:405-616-0113
Practice Address - Fax:405-616-0116
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist