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NPI Code Detail

MEDICARE: MISS EMILY MICHELLE EDELMAN PTA

MEDICARE: MISS EMILY MICHELLE EDELMAN PTA
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
1225200000XPhysical Therapy Assistant3301OK

General Provider Information

NPI Number : 1780298240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS EMILY MICHELLE EDELMAN PTA
Provider Business Mailing Address
First Line : 9201 S I 35 SERVICE RD
Second Line :
City : MOORE
State : OK
Zip : 73160-9046
Country : US
Telephone Number : 405-816-9801
Fax Number :
Provider Business Practice Location Address
First Line : 9201 S I 35 SERVICE RD
Second Line :
City : MOORE
State : OK
Zip : 73160-9046
Country : US
Telephone Number : 405-601-4303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 12/06/2023

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Directions to “ MISS EMILY MICHELLE EDELMAN PTA” Practice Location

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