Provider Demographics
NPI:1881121697
Name:NGARE, MERCY (DPT)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:NGARE
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 1:1710 E 72ND ST
Mailing Address - Street 2:APT # 1301
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5348
Mailing Address - Country:US
Mailing Address - Phone:918-938-2037
Mailing Address - Fax:
Practice Address - Street 1:3219 S 79TH EAST AVE
Practice Address - Street 2:THERAPY DEPARTMENT
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1343
Practice Address - Country:US
Practice Address - Phone:918-660-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist