Provider Demographics
NPI:1780571687
Name:THORNE-BATEMAN, TALA (DPT)
Entity type:Individual
Prefix:
First Name:TALA
Middle Name:
Last Name:THORNE-BATEMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4809
Mailing Address - Country:US
Mailing Address - Phone:918-859-8763
Mailing Address - Fax:
Practice Address - Street 1:4765 E 91ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2843
Practice Address - Country:US
Practice Address - Phone:539-444-4229
Practice Address - Fax:539-444-4487
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist