Provider Demographics
NPI:1194349183
Name:WANSICK, NATALIE DELANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:DELANA
Last Name:WANSICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-8801
Mailing Address - Country:US
Mailing Address - Phone:405-325-5847
Mailing Address - Fax:
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-9046
Practice Address - Country:US
Practice Address - Phone:405-325-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist