Healthcare Provider Details

I. General information

NPI: 1568883155
Provider Name (Legal Business Name): HANNAH HARGIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH MARDIS PT, DPT

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 E 51ST ST
TULSA OK
74135-7430
US

IV. Provider business mailing address

4113 E 30TH ST
TULSA OK
74114-6207
US

V. Phone/Fax

Practice location:
  • Phone: 918-627-5238
  • Fax:
Mailing address:
  • Phone: 580-339-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number4700
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: