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NPI Code Detail

MEDICARE: BLAKE ALLEN

MEDICARE: BLAKE ALLEN
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 Assistant3604OK

General Provider Information

NPI Number : 1619773082
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE ALLEN
Provider Business Mailing Address
First Line : 10703 N GARNETT RD APT E101
Second Line :
City : OWASSO
State : OK
Zip : 74055-8966
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3701 N MARTIN LUTHER KING JR BLVD
Second Line :
City : TULSA
State : OK
Zip : 74106-6450
Country : US
Telephone Number : 918-425-3583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2025
Last Update Date : 02/24/2025

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Directions to “ BLAKE ALLEN ” Practice Location

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