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General NPI Number Information
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NPI Number | 1659993947
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Entity Type | Individual
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Provider Name | PHYLLIS MARJANN ROSSON PTA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 111 S YORK ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5952
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Country | US
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Telephone | 918-682-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 ELMIRA ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-3817
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Country | US
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Telephone | 918-869-9301
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | TA922
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License Number State | OK
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