Individual
STACEY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4808 S 109TH EAST AVE, SUITE 100, TULSA, OK 74146-5822
(918) 392-1482
Mailing address
4808 S 109TH EAST AVE, SUITE 100, TULSA, OK 74146-5822
(918) 392-1482
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2734
OK
Other
Enumeration date
04/08/2016
Last updated
04/08/2016
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