Provider Demographics
NPI:1255916557
Name:HOWL SPORT & SPINE, LLC
Entity type:Organization
Organization Name:HOWL SPORT & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:405-265-8022
Mailing Address - Street 1:17513 BRAKEN DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-1247
Mailing Address - Country:US
Mailing Address - Phone:405-265-8022
Mailing Address - Fax:
Practice Address - Street 1:17513 BRAKEN DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-1247
Practice Address - Country:US
Practice Address - Phone:405-265-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy