MEDICARE: MAXWELL DOUGLAS HILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		OK

General Provider Information

NPI Number	:	1053241927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL DOUGLAS HILLER

Provider Business Mailing Address
First Line	:	7217 E 64TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-7510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 S 101ST EAST AVE STE 170
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5799
Country	:	US
Telephone Number	:	918-294-4060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ MAXWELL DOUGLAS HILLER ” Practice Location

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