1942632716 NPI number — MRS. BRITTANY RENEE GARTNER DPT

Table of content: MRS. BRITTANY RENEE GARTNER DPT (NPI 1942632716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942632716 NPI number — MRS. BRITTANY RENEE GARTNER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARTNER
Provider First Name:
BRITTANY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIXSON
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942632716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4157 S. HARVARD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-949-4390
Provider Business Mailing Address Fax Number:
918-392-7878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4157 S. HARVARD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-949-4390
Provider Business Practice Location Address Fax Number:
918-392-7878
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4755 , 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: 200509710A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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