Provider Demographics
NPI:1669868386
Name:NEWBOLD, THERESA MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MICHELLE
Last Name:NEWBOLD
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 1:7919 MID AMERICA BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6618
Mailing Address - Country:US
Mailing Address - Phone:405-400-2273
Mailing Address - Fax:
Practice Address - Street 1:7919 MID AMERICA BLVD STE 240
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6618
Practice Address - Country:US
Practice Address - Phone:405-400-2273
Practice Address - Fax:405-870-1400
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist