Provider Demographics
NPI:1184331548
Name:BYNUM, DORI (LPTA)
Entity type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13893 RED ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BYARS
Mailing Address - State:OK
Mailing Address - Zip Code:74831-7609
Mailing Address - Country:US
Mailing Address - Phone:405-570-6580
Mailing Address - Fax:
Practice Address - Street 1:13893 RED ROCK AVE
Practice Address - Street 2:
Practice Address - City:BYARS
Practice Address - State:OK
Practice Address - Zip Code:74831-7609
Practice Address - Country:US
Practice Address - Phone:405-570-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant