Provider Demographics
NPI:1174770226
Name:THIESSEN, AMY SUSANNE
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUSANNE
Last Name:THIESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4602
Mailing Address - Country:US
Mailing Address - Phone:405-271-6242
Mailing Address - Fax:405-271-2887
Practice Address - Street 1:820 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4602
Practice Address - Country:US
Practice Address - Phone:405-271-6242
Practice Address - Fax:405-271-2887
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist