Provider Demographics
NPI:1437279890
Name:UNTALAN QUERUBIN, ARMIDA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ARMIDA
Middle Name:
Last Name:UNTALAN QUERUBIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:ARMIDA
Other - Middle Name:
Other - Last Name:UNTALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:834 FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-0804
Mailing Address - Country:US
Mailing Address - Phone:580-504-4033
Mailing Address - Fax:580-490-9960
Practice Address - Street 1:604 LAKE MURRAY DR E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3851
Practice Address - Country:US
Practice Address - Phone:580-223-4501
Practice Address - Fax:580-223-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT 2347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist