Provider Demographics
NPI:1922510775
Name:TOMASI, MIKAYLA (PTA)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:TOMASI
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 3542
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-3542
Mailing Address - Country:US
Mailing Address - Phone:405-513-8118
Mailing Address - Fax:405-513-6490
Practice Address - Street 1:3500 S BOULEVARD STE A1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5490
Practice Address - Country:US
Practice Address - Phone:405-513-8118
Practice Address - Fax:405-513-6490
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2827225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant