Healthcare Provider Details

I. General information

NPI: 1205046091
Provider Name (Legal Business Name): THOMAS WILLIAM MCCALEB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

127 W 119TH ST S
JENKS OK
74037-3631
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-1471
  • Fax:
Mailing address:
  • Phone: 918-298-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTA548
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: