Healthcare Provider Details

I. General information

NPI: 1659751923
Provider Name (Legal Business Name): BEVERLY HASSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MAHANEY AVE STE 6
TAHLEQUAH OK
74464-5795
US

IV. Provider business mailing address

PO BOX 721018
NORMAN OK
73070-4786
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-5115
  • Fax: 918-458-5119
Mailing address:
  • Phone: 405-809-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4794
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: