Suzn Davis Delfosse

Individual provider Active NPI Physical Therapy Assistant · Madill, OK

NPI 1669633111 · NPPES record last updated Jun 18, 2008

Key facts

NPI
1669633111
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
1622 (NC)
Practice address
105 N 5TH Ave
Madill, OK 73446-1203
Phone
(580) 795-3301
Fax
(580) 795-7307
NPI assigned
Jun 18, 2008
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1622NCMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 1622 NC Yes

Addresses

Primary practice location

105 N 5TH Ave
Madill, OK 73446-1203

Mailing address

PO Box 831
Madill, OK 73446-0831
Phone (580) 795-3301

Other providers in Madill, OK

All providers in Madill, OK · Physical Therapy Assistant in Oklahoma

Sources for this page

Verify at the official NPI Registry.