Individual
ELIJAH JOSEPH TEDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2821 36TH AVE NW STE 130, NORMAN, OK 73072-2472
(405) 310-5224
(405) 310-5225
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
(813) 560-8157
(812) 590-8333
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
014468
AZ
225200000X
Physical Therapy Assistant
Primary
2970
OK
225200000X
Physical Therapy Assistant
A8125
NC
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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