Provider Demographics
NPI:1043885155
Name:MAXEY, TRUMAN MCCOMBS
Entity Type:Individual
Prefix:MR
First Name:TRUMAN
Middle Name:MCCOMBS
Last Name:MAXEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10113 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-7465
Mailing Address - Country:US
Mailing Address - Phone:918-798-7768
Mailing Address - Fax:
Practice Address - Street 1:4908 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5712
Practice Address - Country:US
Practice Address - Phone:918-984-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2967OtherOKLAHOMA MEDICAL BOARD- PHYSICAL THERAPY ASSISTANT LICENSE