Provider Demographics
NPI:1295940203
Name:FLUITT, AUDREY LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LYNN
Last Name:FLUITT
Suffix:
Gender:F
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:RR 3 BOX 423A
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OK
Mailing Address - Zip Code:74881-9459
Mailing Address - Country:US
Mailing Address - Phone:405-258-0788
Mailing Address - Fax:
Practice Address - Street 1:5300 N INDEPENDENCE AVE
Practice Address - Street 2:STE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5556
Practice Address - Country:US
Practice Address - Phone:405-945-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics