Active NPI
Deric Fenzl, DPT
- Physical Therapist
- Pryor, OK
National Provider Identifier
1699295162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5348
- Practice address
- 1486 S Elliott St
Pryor, OK 74361-8002 - Phone
- (918) 825-2333
- Fax
- (918) 825-6266
- NPI assigned
- Jun 26, 2017
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | 5348 | OK | Primary |
Addresses
Primary practice location
1486 S Elliott St
Pryor, OK 74361-8002
Mailing address
4812 E 33Rd St
Tulsa, OK 74135-2038
Phone (918) 622-4126
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5348 | OK | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498435200000",
"number": "1699295162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4812 E 33RD ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741352038",
"telephone_number": "918-622-4126",
"fax_number": "918-270-2398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1486 S ELLIOTT ST",
"city": "PRYOR",
"state": "OK",
"postal_code": "743618002",
"telephone_number": "918-825-2333",
"fax_number": "918-825-6266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENZL",
"first_name": "DERIC",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-26",
"last_updated": "2017-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "5348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pryor, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.