Individual
EDWIN L DETWEILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, PTA
Contact information
Practice address
100 CAMPUS DR, WEATHERFORD, OK 73096-3001
(864) 616-4448
Mailing address
100 CAMPUS DR, WEATHERFORD, OK 73096-3001
(864) 616-4448
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1021
OK
2255A2300X
Athletic Trainer
Primary
624
OK
Other
Enumeration date
10/01/2010
Last updated
11/22/2011
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