Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT2525 | OK |
N | 2251C2600X | Cardiopulmonary | PT2525 | OK |
N | 2251N0400X | Physical Therapist - Neurology | PT2525 | OK |
N | 2251S0007X | Physical Therapist - Sports | PT2525 | OK |
N | 2251X0800X | Physical Therapist - Orthopedic | PT2525 | OK |
NPI | 1295949022 |
---|---|
Provider Name | Mr. Mark Dee Hildebrand |
First Address | Tulsa, OK 74133-4511 |
Second Address | Sapulpa, OK 74066-4513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |