Active NPI
Maston Bradley Wolfe III, MPT
- Physical Therapy Clinic/Center
- Oklahoma City, OK
National Provider Identifier
1669668042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- 4004
- Practice address
- 6525 N Meridian Ave
Suite 311
Oklahoma City, OK 73116-1420 - Phone
- (405) 721-1115
- Fax
- (405) 728-1115
- NPI assigned
- Sep 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 4004 | OK | Primary |
Addresses
Primary practice location
6525 N Meridian Ave
Suite 311
Oklahoma City, OK 73116-1420
Mailing address
6525 N Meridian Ave
Suite 311
Oklahoma City, OK 73116-1420
Phone (405) 721-1115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4004 | OK | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Careerstaff | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Oklahoma City, OK
- NPI 1891047353
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1669668042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6525 N MERIDIAN AVE",
"address_2": "SUITE 311",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731161420",
"telephone_number": "405-721-1115",
"fax_number": "405-728-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6525 N MERIDIAN AVE",
"address_2": "SUITE 311",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731161420",
"telephone_number": "405-721-1115",
"fax_number": "405-728-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFE",
"first_name": "MASTON",
"middle_name": "BRADLEY",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "OK",
"license": "4004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.