Provider Demographics
NPI:1780499145
Name:HASKINS, SCOTTLAND CORNELIUS (DPT)
Entity type:Individual
Prefix:
First Name:SCOTTLAND
Middle Name:CORNELIUS
Last Name:HASKINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:SCOTTLAND
Other - Middle Name:CORNELIUS
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:12 RYAN PL
Mailing Address - Street 2:
Mailing Address - City:KIEFER
Mailing Address - State:OK
Mailing Address - Zip Code:74041-4558
Mailing Address - Country:US
Mailing Address - Phone:405-779-5530
Mailing Address - Fax:
Practice Address - Street 1:7300 E 121ST PL S
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-5875
Practice Address - Country:US
Practice Address - Phone:877-215-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist