Individual
LUCAS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9709 E 79TH ST, TULSA, OK 74133-4566
(918) 994-4000
Mailing address
9709 E 79TH ST, TULSA, OK 74133-4566
(918) 994-4000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2905
OK
Other
Enumeration date
08/13/2018
Last updated
07/01/2026
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