Melissia W Pettigrew, PT
Individual provider Active NPI Physical Therapist · Keota, OK
NPI 1982828059 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1982828059
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT2322 (OK)
- Practice address
- 14499 Kerr Lake Rd
Keota, OK 74941-6554 - Phone
- (918) 966-3104
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2322 | OK | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2322 | OK | Yes |
Addresses
Primary practice location
14499 Kerr Lake Rd
Keota, OK 74941-6554
Mailing address
14499 Kerr Lake Rd
Keota, OK 74941-6554
Phone (918) 966-3104
Other providers in Keota, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.