Individual
BLAKELEY MATTHEW WHITBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
807 E JEFFERSON ST, HUGO, OK 74743-4807
(580) 317-7455
Mailing address
807 E JEFFERSON ST, HUGO, OK 74743-4807
(580) 317-7455
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2126370
TX
225200000X
Physical Therapy Assistant
Primary
2709
OK
Other
Enumeration date
12/26/2018
Last updated
12/26/2018
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