Provider Demographics
NPI:1003231879
Name:HILL, PHILIP LEE (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:LEE
Last Name:HILL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SW 4TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5409
Mailing Address - Country:US
Mailing Address - Phone:405-759-2700
Mailing Address - Fax:405-759-2722
Practice Address - Street 1:409 DAISY DR
Practice Address - Street 2:STE F2
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-7410
Practice Address - Country:US
Practice Address - Phone:918-458-9235
Practice Address - Fax:918-458-9236
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200527630AMedicaid
OK346931YUQZMedicare PIN