Individual
MR. LEE KENNETH HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4004 S YALE AVE, TULSA, OK 74135-6017
(918) 622-4278
(918) 622-4844
Mailing address
4004 S YALE AVE, TULSA, OK 74135-6017
(918) 622-4278
(918) 622-4844
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2359
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200094780A
MEDICAID LEGACY
—
05
—
200094780A
—
OK
01
—
243631705
MEDICARE LEGACY
—
01
—
444649810010
BCBS LEGACY
—
01
—
7589153
AETNA
—
01
—
P00382679
MEDICARE RAILRAOD
—
Enumeration date
02/03/2006
Last updated
10/23/2007
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