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General NPI Number Information
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NPI Number | 1619773082
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Entity Type | Individual
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Provider Name | BLAKE ALLEN
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Gender |
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 3701 N MARTIN LUTHER KING JR BLVD
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City | TULSA
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State | OK
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Zip | 74106-6450
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Country | US
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Telephone | 918-425-3583
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Fax |
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Provider Business Mailing Address
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Address Line | 10703 N GARNETT RD APT E101
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City | OWASSO
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State | OK
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Zip | 74055-8966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3604
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License Number State | OK
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