Individual
MR. LEE KENNETH HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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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