Provider Demographics
NPI:1265928956
Name:STOCKARD, HAYLEE M (PT)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:M
Last Name:STOCKARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HAYLEE
Other - Middle Name:M
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4808 S 109TH EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-392-1482
Mailing Address - Fax:
Practice Address - Street 1:4808 S 109TH EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5822
Practice Address - Country:US
Practice Address - Phone:918-392-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist