Provider Demographics
NPI:1235748229
Name:JOYFUL HEART PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:JOYFUL HEART PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MESSMER-TUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:918-284-4220
Mailing Address - Street 1:2608 W KENOSHA ST # 496
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8952
Mailing Address - Country:US
Mailing Address - Phone:918-284-4220
Mailing Address - Fax:918-249-2817
Practice Address - Street 1:2608 W KENOSHA ST # 496
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8952
Practice Address - Country:US
Practice Address - Phone:918-284-4220
Practice Address - Fax:918-249-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100665910CMedicaid