NPIMap

Organization Active NPI

Cutting Edge Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Yukon, OK
National Provider Identifier
1205352028
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
CUTTING EDGE PHYSICAL THERAPY PLLC
Practice address
1805 Commons Cir Ste 100-B
Yukon, OK 73099-9519
Phone
(405) 265-1628
Fax
(405) 265-1929
NPI assigned
Aug 15, 2017
Last updated
Sep 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CUTTING EDGE PHYSICAL THERAPY, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawn WallaceNPI 1457323396
Title
Owner
Phone
(405) 265-1628

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

1805 Commons Cir Ste 100-B
Yukon, OK 73099-9519

Mailing address

526 SW 4TH St Ste 200
Moore, OK 73160-5409
Phone (405) 759-2700

National Provider Directory

National Provider Directory
Part of
Cutting Edge Physical Therapy PLLC

Locations

526 SW 4th St
Ste 200
Moore, OK 73160
Phone (405) 759-2700

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1205352028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SW 4TH ST STE 200",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731605409",
            "telephone_number": "405-759-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 COMMONS CIR STE 100-B",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730999519",
            "telephone_number": "405-265-1628",
            "fax_number": "405-265-1929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUTTING EDGE PHYSICAL THERAPY PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CUTTING EDGE PHYSICAL THERAPY, PLLC",
        "enumeration_date": "2017-08-15",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-265-1628"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.