MEDICARE: TALEASHA HARVEY 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
1	225200000X	Physical Therapy Assistant	3457	OK

General Provider Information

NPI Number	:	1942977368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALEASHA HARVEY PTA

Provider Business Mailing Address
First Line	:	PO BOX 721018
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-4786
Country	:	US
Telephone Number	:	918-622-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 S MAIN ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-2800
Country	:	US
Telephone Number	:	918-786-9883
Fax Number	:

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

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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Directions to “ TALEASHA HARVEY PTA” Practice Location

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