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NPI Code Detail

MEDICARE: MISS DANA MARIE MCGILL PTA

MEDICARE: MISS DANA MARIE MCGILL 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 AssistantPTA 1548OK

General Provider Information

NPI Number : 1912028614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS DANA MARIE MCGILL PTA
Provider Business Mailing Address
First Line : PO BOX 72
Second Line :
City : WYNONA
State : OK
Zip : 74084-0072
Country : US
Telephone Number : 918-637-7466
Fax Number : 918-358-3307
Provider Business Practice Location Address
First Line : 1401 W PAWNEE ST
Second Line :
City : CLEVELAND
State : OK
Zip : 74020-3033
Country : US
Telephone Number : 918-358-2501
Fax Number : 918-358-3307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 03/10/2011

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Directions to “ MISS DANA MARIE MCGILL PTA” Practice Location

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