Provider Demographics
NPI:1184486136
Name:WILSON, LYNZIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LYNZIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LYNZIE
Other - Middle Name:
Other - Last Name:NUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:DRUMRIGHT
Mailing Address - State:OK
Mailing Address - Zip Code:74030-5810
Mailing Address - Country:US
Mailing Address - Phone:918-225-9631
Mailing Address - Fax:
Practice Address - Street 1:1023 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4105
Practice Address - Country:US
Practice Address - Phone:918-225-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist