Provider Demographics
NPI:1841667896
Name:MAGNESS, CARLETTA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARLETTA
Middle Name:
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 OAK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3730
Mailing Address - Country:US
Mailing Address - Phone:405-413-4081
Mailing Address - Fax:
Practice Address - Street 1:3716 OAK GROVE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3730
Practice Address - Country:US
Practice Address - Phone:405-413-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3474171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11061972Medicaid
OK0011061972Medicare NSC