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NPI Code Detail

MEDICARE: DIANA IRENE EMERSON PTA

MEDICARE: DIANA IRENE EMERSON PTA
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
1225200000XPhysical Therapy Assistant581OK

General Provider Information

NPI Number : 1215716733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA IRENE EMERSON PTA
Provider Business Mailing Address
First Line : 9017 N UNIVERSITY AVE APT 15103
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-4313
Country : US
Telephone Number : 405-264-7704
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1240
Country : US
Telephone Number : 405-875-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2023
Last Update Date : 09/25/2023

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Directions to “ DIANA IRENE EMERSON PTA” Practice Location

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