Provider Demographics
NPI:1912028614
Name:MCGILL, DANA MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:MARIE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:WYNONA
Mailing Address - State:OK
Mailing Address - Zip Code:74084-0072
Mailing Address - Country:US
Mailing Address - Phone:918-637-7466
Mailing Address - Fax:918-358-3307
Practice Address - Street 1:1401 W PAWNEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3033
Practice Address - Country:US
Practice Address - Phone:918-358-2501
Practice Address - Fax:918-358-3307
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPTA 1548225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant