Individual
MR. MATTHEW JOHN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
4004 S YALE AVE, TULSA, OK 74135-6017
(918) 622-4126
(918) 270-2398
Mailing address
201 N 4TH ST, WEATHERFORD, OK 73096-4636
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4036
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200135840A
—
OK
Enumeration date
09/20/2007
Last updated
06/30/2008
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