Organization
MEDICAL MUSCLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVEN T SULLIVAN (ADMINISTRATOR)
(919) 625-6512
Entity
Organization
Contact information
Practice address
109 S 9TH ST APT 210, BROKEN ARROW, OK 74012-4228
(919) 625-6512
Mailing address
109 S 9TH ST APT 210, BROKEN ARROW, OK 74012-4228
(919) 625-6512
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372500000X
Chore Provider
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
07/06/2024
Last updated
07/06/2024
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