Provider Demographics
NPI:1366706889
Name:FIELDING, ELIZABETH EDISON (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EDISON
Last Name:FIELDING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1505 ROCK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-9676
Mailing Address - Country:US
Mailing Address - Phone:918-760-0321
Mailing Address - Fax:918-358-5230
Practice Address - Street 1:910 W CADDO ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4202
Practice Address - Country:US
Practice Address - Phone:918-760-0321
Practice Address - Fax:918-358-5230
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist