Provider Demographics
NPI:1316234073
Name:STANDEFER, ALLYSON (DPT)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:
Last Name:STANDEFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:CIESIELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6720 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4044
Mailing Address - Country:US
Mailing Address - Phone:580-484-1390
Mailing Address - Fax:
Practice Address - Street 1:11 PALM AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5645
Practice Address - Country:US
Practice Address - Phone:405-350-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist