Individual
MERLE BASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3308 W OKMULGEE ST, MUSKOGEE, OK 74401-5069
(918) 683-7731
Mailing address
21092 E 102ND ST, BROKEN ARROW, OK 74014-3617
(918) 449-0503
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2106
LICENSE #
OK
Enumeration date
08/25/2006
Last updated
07/08/2007
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