Fundamental Physical Therapy PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

821 Issued in OK

Legal business name

FUNDAMENTAL PHYSICAL THERAPY PLLC

Practice address

3500 S Boulevard
Suite A1
Edmond, OK 73013-5486

Phone

(405) 518-8118

NPI assigned

Dec 15, 2009

Last updated

Sep 1, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debra Sue Clark, DPTNPI 1720178650

Title

Owner

Phone

(405) 513-8118

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

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.

• Debra Sue Clark, PT

  • Orthopedic Physical Therapist
  • Edmond, OK
  • NPI 1720178650
  Medicare reassignment Care Compare group NPD Authorized official
• Kathy Sue Bonar, PT

  • Orthopedic Physical Therapist
  • Edmond, OK
  • NPI 1629339718
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1260835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1215266671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3542",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730833542",
            "telephone_number": "405-513-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S BOULEVARD",
            "address_2": "SUITE A1",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135486",
            "telephone_number": "405-518-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-15",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-513-8118",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OK",
            "license": "821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Fuller
• Jennifer J Fulmer, APRN
• Function First Therapy Inc
• Function Physical Therapy, LLC
• Function Physical Therapy, LLC
• Brandon Scott Funk, PA-C
• Angela Rae Funkhouser, COTA/L
• Victoria Funner
• Amanda Faye Furry, D.C.
• Kimberly Fuxa, APRN

• Physical Therapy Clinic/Center in Edmond, OK
• Providers in Edmond, OK by specialty
• Physical Therapy Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.