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General NPI Number Information
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NPI Number | 1669945804
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Entity Type | Organization
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Legal Business Name | HEARTLAND THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 102 W ROGERS BLVD. SKIATOOK
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City | SKIATOOK
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State | OK
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Zip | 74070-7407
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Country | US
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Telephone | 918-724-4779
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Fax | 888-284-2781
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Provider Business Mailing Address
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Address Line | 4198 HOBBY HORSE LN
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City | SKIATOOK
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State | OK
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Zip | 74070-9361
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Country | US
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Telephone | 918-724-4779
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Fax | 888-284-2781
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Authorized Official
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Title or Position | OWNER-COUNSELING
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Name | TERRILL PAUL WATSON
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Credential | LPC
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Telephone | 918-724-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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