Provider Demographics
NPI:1902844582
Name:PHYSICAL THERAPY SERVICES OF BARTLESVILLE INC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF BARTLESVILLE INC
Other - Org Name:BARTLESVILLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-331-9922
Mailing Address - Street 1:4100 SE ADAMS RD
Mailing Address - Street 2:SUITE A100
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8409
Mailing Address - Country:US
Mailing Address - Phone:918-331-9922
Mailing Address - Fax:918-331-9971
Practice Address - Street 1:4100 SE ADAMS RD
Practice Address - Street 2:SUITE A100
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8409
Practice Address - Country:US
Practice Address - Phone:918-331-9922
Practice Address - Fax:918-331-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1067200001Medicare NSC
OK=========Medicare UPIN