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General NPI Number Information
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NPI Number | 1710007208
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Entity Type | Individual
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Provider Name | EDWIN MELVIN
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12221 E 51ST ST STE A
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City | TULSA
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State | OK
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Zip | 74146-6216
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Country | US
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Telephone | 918-249-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 9224 S 95TH EAST AVE
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City | TULSA
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State | OK
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Zip | 74133-5600
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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 | 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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