Healthcare Provider Details

I. General information

NPI: 1285203448
Provider Name (Legal Business Name): ELIZABETH A HANCOCK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE HANCOCK PTA

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11414 E 51ST ST STE E
TULSA OK
74146-5823
US

IV. Provider business mailing address

7402 W 34TH PL
TULSA OK
74107-4508
US

V. Phone/Fax

Practice location:
  • Phone: 918-249-0623
  • Fax:
Mailing address:
  • Phone: 918-695-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number283
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: