Provider Demographics
NPI:1528154408
Name:MCINTOSH, DAVID BENJAMIN (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BENJAMIN
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E 13TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4431
Mailing Address - Country:US
Mailing Address - Phone:918-392-1400
Mailing Address - Fax:
Practice Address - Street 1:4802 S 109TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-392-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7757857OtherAETNA
200098040AOtherMEDICAID LEGACY
245702903OtherMEDICARE LEGACY
P00407587OtherMEDICARE RAILROAD
OK200098040AMedicaid
245702903OtherMEDICARE LEGACY