Healthcare Provider Details

I. General information

NPI: 1497469613
Provider Name (Legal Business Name): CHANDRA MURRELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 W GORE BLVD
LAWTON OK
73505-5998
US

IV. Provider business mailing address

2202 NW OZMUN AVE
LAWTON OK
73505-2146
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-6785
  • Fax:
Mailing address:
  • Phone: 580-458-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2535
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: