Healthcare Provider Details

I. General information

NPI: 1427133909
Provider Name (Legal Business Name): MARILYN L ALLEN PT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE SUITE 604
TULSA OK
74104-5638
US

IV. Provider business mailing address

1919 S WHEELING AVE SUITE 604
TULSA OK
74104-5635
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7500
  • Fax: 918-748-7615
Mailing address:
  • Phone: 918-748-7500
  • Fax: 918-748-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number1090
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: