Provider Demographics
NPI:1780754705
Name:DURANT PHYSICAL THERAPY INC, PC
Entity type:Organization
Organization Name:DURANT PHYSICAL THERAPY INC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:580-920-2231
Mailing Address - Street 1:3004 W UNIVERSITY BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2998
Mailing Address - Country:US
Mailing Address - Phone:580-920-2231
Mailing Address - Fax:580-920-2242
Practice Address - Street 1:3004 W UNIVERSITY BLVD
Practice Address - Street 2:STE 101
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2998
Practice Address - Country:US
Practice Address - Phone:580-920-2231
Practice Address - Fax:580-920-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2365225100000X
TX1133726225100000X
OKPT2379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200057810AMedicaid
OKDD5543OtherRR MEDICARE
OK611622500OtherUS DEPT OF LABOR
OKDD5543OtherRR MEDICARE
OK611622500OtherUS DEPT OF LABOR