MEDICARE: PHYLLYNNA CHRISTINNA HURTUBISE L.M.T.,

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	106S00000X	Behavior Technician
2	175T00000X	Peer Specialist
3	225700000X	Massage Therapist	H2598	OK

General Provider Information

NPI Number	:	1114250305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLYNNA CHRISTINNA HURTUBISE L.M.T.,

Provider Business Mailing Address
First Line	:	4908 S 79TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-6411
Country	:	US
Telephone Number	:	918-770-9913
Fax Number	:

Provider Business Practice Location Address
First Line	:	4908 S 79TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-6411
Country	:	US
Telephone Number	:	918-770-9913
Fax Number	:

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

Provider Enumeration Date	:	09/07/2009
Last Update Date	:	06/28/2024

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