Provider Demographics
NPI:1194319319
Name:RICE, AMY LEIGH (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:RICE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 S ROBERT GIRTEN RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-4058
Mailing Address - Country:US
Mailing Address - Phone:918-557-3634
Mailing Address - Fax:
Practice Address - Street 1:6006 SE ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8960
Practice Address - Country:US
Practice Address - Phone:918-331-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3303225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant