Provider Demographics
NPI:1013388305
Name:HILLMAN, MYSHA KAROL (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MYSHA
Middle Name:KAROL
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:MYSHA
Other - Middle Name:KAROL
Other - Last Name:EWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2322 S EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3244
Mailing Address - Country:US
Mailing Address - Phone:405-612-5552
Mailing Address - Fax:
Practice Address - Street 1:2322 S EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3244
Practice Address - Country:US
Practice Address - Phone:405-612-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist