Provider Demographics
NPI:1376857367
Name:MUILENBURG, PATRICK JOSHUA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSHUA
Last Name:MUILENBURG
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 1:938 W SHAWNEE ST # B
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-3511
Mailing Address - Country:US
Mailing Address - Phone:918-683-7731
Mailing Address - Fax:918-683-6244
Practice Address - Street 1:938 W SHAWNEE ST # B
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-3511
Practice Address - Country:US
Practice Address - Phone:918-683-7731
Practice Address - Fax:918-683-6244
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist