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Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist

Provider NPI: 1902041338

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 918-425-4000  Fax: 918-428-0781

Business Mailing Address:
1748 W WOODROW ST  TULSA, OK 74127-2511 US
Tel: --  Fax: --

NPI Information:
NPI: 1902041338
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 225100000X





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