Provider Demographics
NPI:1598504425
Name:WORLEY, NATHANIEL JOSIAH (DPT, PT)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JOSIAH
Last Name:WORLEY
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 TWILIGHT TER
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3388
Mailing Address - Country:US
Mailing Address - Phone:580-279-7515
Mailing Address - Fax:
Practice Address - Street 1:2831 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7005
Practice Address - Country:US
Practice Address - Phone:405-602-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist