Provider Demographics
NPI:1588077952
Name:PESTEL-NOLAND, CHRISTY MARIE (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MARIE
Last Name:PESTEL-NOLAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TINA TRL
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7468
Mailing Address - Country:US
Mailing Address - Phone:918-557-5946
Mailing Address - Fax:
Practice Address - Street 1:1541 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-4610
Practice Address - Country:US
Practice Address - Phone:918-836-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist