Provider Demographics
NPI:1497766489
Name:MILLET, RHONDA LEA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:LEA
Last Name:MILLET
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5804
Mailing Address - Country:US
Mailing Address - Phone:918-599-0440
Mailing Address - Fax:
Practice Address - Street 1:1310 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5804
Practice Address - Country:US
Practice Address - Phone:918-599-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00326999OtherMEDICARE RAILROAD
200079130AOtherMEDICAID LEGACY
7201672OtherAETNA LEGACY
OK200079130AMedicaid
243605203OtherMEDICARE LEGACY
243605203OtherMEDICARE LEGACY