Basic Information
| Provider Information | |||||||||
| NPI: | 1093836694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOTO | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | AGARAN | ||||||||
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| Credential: | PT, RN, CWS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | PONCA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 746042018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807626009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 N 14TH ST | ||||||||
| Address2: | |||||||||
| City: | PONCA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 746012035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807650518 | ||||||||
| FaxNumber: | 5807650203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | OK 1617 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.