Provider Demographics
NPI:1396334082
Name:GRAYSON STARBUCK, DPT, PLLC
Entity type:Organization
Organization Name:GRAYSON STARBUCK, DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAYSON
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:STARBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:405-633-0783
Mailing Address - Street 1:11900 N MACARTHUR BLVD # F7
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1801
Mailing Address - Country:US
Mailing Address - Phone:405-633-0783
Mailing Address - Fax:405-896-8414
Practice Address - Street 1:11900 N MACARTHUR BLVD # F7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1801
Practice Address - Country:US
Practice Address - Phone:405-633-0783
Practice Address - Fax:405-896-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-16
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty