Provider Demographics
NPI:1831297779
Name:MISER, MYNDA (PT)
Entity Type:Individual
Prefix:
First Name:MYNDA
Middle Name:
Last Name:MISER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MYNDA
Other - Middle Name:
Other - Last Name:SURITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11211 N GARNETT RD STE B
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4243
Mailing Address - Country:US
Mailing Address - Phone:918-553-1122
Mailing Address - Fax:833-840-6360
Practice Address - Street 1:11211 N GARNETT RD STE B
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4243
Practice Address - Country:US
Practice Address - Phone:918-553-1122
Practice Address - Fax:833-840-6360
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3493OtherLICENSE