Provider Demographics
NPI:1811981798
Name:PHYSICAL THERAPY CONSULTANTS OF TULSA INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CONSULTANTS OF TULSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:
Authorized Official - First Name:MARGY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:918-743-2988
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-743-2988
Mailing Address - Fax:918-743-3248
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:STE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-743-2988
Practice Address - Fax:918-743-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK650016749OtherRR MEDICARE
OK200256890AMedicaid
OK650016749OtherRR MEDICARE
OK200256890AMedicaid
OK=========001OtherBLUE LINCS HMO
OK=========001OtherBCBS