Individual
SHANNON HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
717 S MISSION ST, SAPULPA, OK 74066-4659
(918) 227-7878
Mailing address
PO BOX 721018, NORMAN, OK 73070-4786
(918) 270-1378
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2649
OK
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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