Individual provider Active NPI

Betty Jo Poorboy, PTA

  • Physical Therapy Assistant
  • Broken Arrow, OK
National Provider Identifier
1730585340
Registry record updated Nov 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
1847 Issued in OK
Practice address
3207 E Fairmont PL
Broken Arrow, OK 74014-8796
Phone
(918) 521-9592
NPI assigned
Nov 8, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 1847 OK Primary

Addresses

Primary practice location

3207 E Fairmont PL
Broken Arrow, OK 74014-8796

Mailing address

3207 E Fairmont PL
Broken Arrow, OK 74014-8796
Phone (918) 521-9592

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

LicenseStateTypeSpecialty
1847OKMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1415404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415404800000",
    "number": "1730585340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 E FAIRMONT PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740148796",
            "telephone_number": "918-521-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 E FAIRMONT PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740148796",
            "telephone_number": "918-521-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POORBOY",
        "first_name": "BETTY",
        "middle_name": "JO",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-08",
        "last_updated": "2014-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OK",
            "license": "1847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2014; 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.