Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4334 | OK |
NPI | 1003231879 |
---|---|
Provider Name | Philip Lee Hill |
First Address | Moore, OK 73160-5409 |
Second Address | Tahlequah, OK 74464-7410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200527630A | (05) | OK |