1376849364 NPI number — MELODY THOMASON, PT, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376849364 NPI number — MELODY THOMASON, PT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELODY THOMASON, PT, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376849364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73157-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-605-1466
Provider Business Mailing Address Fax Number:
405-605-1467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6108 NW 63RD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73132-7553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-605-1466
Provider Business Practice Location Address Fax Number:
405-605-1467
Provider Enumeration Date:
02/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMASON
Authorized Official First Name:
MELODY
Authorized Official Middle Name:
RONNAE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
405-517-8387

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  1696 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100835160B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".