Provider Demographics
NPI:1477550101
Name:MESSMER-TUNNELL, MONICA E (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:E
Last Name:MESSMER-TUNNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2077208100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK02710OtherBLUE CROSS BLUE SHIELD
OK100665910CMedicaid
OK3952320OtherAETNA