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NPI Code Detail

MEDICARE: EVAN BLAISE FLANAGAN DPT

MEDICARE: EVAN BLAISE FLANAGAN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5442OK

General Provider Information

NPI Number : 1205335239
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN BLAISE FLANAGAN DPT
Provider Business Mailing Address
First Line : 6153 S QUEBEC AVE
Second Line :
City : TULSA
State : OK
Zip : 74136-1608
Country : US
Telephone Number : 918-760-4045
Fax Number :
Provider Business Practice Location Address
First Line : 7401 RIVERSIDE PKWY UNIT 219
Second Line :
City : TULSA
State : OK
Zip : 74136-5057
Country : US
Telephone Number : 918-216-9303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2018
Last Update Date : 08/26/2024

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Directions to “ EVAN BLAISE FLANAGAN DPT” Practice Location

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