Provider Demographics
NPI:1285203448
Name:HANCOCK, ELIZABETH A (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:7402 W 34TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-4508
Mailing Address - Country:US
Mailing Address - Phone:918-695-7850
Mailing Address - Fax:
Practice Address - Street 1:11414 E 51ST ST STE E
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5823
Practice Address - Country:US
Practice Address - Phone:918-249-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK283225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant