ELMORE, TRAVIS RYAN - Licensee Information

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

ELMORE, TRAVIS RYAN

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	FUNDAMENTALS PEDIATRIC THERAPY CENTER 1402 BROOKVIEW ARDMORE OK 73401 Address last updated on 8/7/2024
Phone #:	(580) 850-1160
Fax #:
County:	CARTER
License:	2450
Dated:	2/1/2015
Expires:	1/31/2025
Temp. Ltr. Issued:	10/10/2014
Temp. Ltr. Expires:	3/13/2015
License Type:	Physical Therapist Assistant
Specialty:

Status:	Active
Status Class:	Fully Licensed
Restricted to:
CME Year:	2026

Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Locations:	Hours:	Languages:
FUNDAMENTALS PEDIATRIC THERAPY CENTER 1402 BROOKVIEW ARDMORE OK 73401 Phone #: (580) 850-1160 Fax #:

Name:	Type:	License Number:
Primary Supervisor(s):
CHELSEA LEE	PTC	13013
CLAYTON COLE WARREN	PT	3927

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