Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 4614 | OK |
NPI | 1053656876 |
---|---|
Provider Name | Dr. Phillip Thomas Studebaker |
First Address | Norman, OK 73069-8603 |
Second Address | Norman, OK 73071-7420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2012 |
Last Update Date | 05/12/2012 |