Provider Demographics
NPI:1063227304
Name:CLINKENBEARD, AMY CHRISTINE (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:CLINKENBEARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4508 BRIAR FOREST CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-9226
Mailing Address - Country:US
Mailing Address - Phone:405-641-2742
Mailing Address - Fax:
Practice Address - Street 1:4508 BRIAR FOREST CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-9226
Practice Address - Country:US
Practice Address - Phone:405-641-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist