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Individual

MR. KENNETH WAYNE WATERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, MBA

Contact information

Practice address
2704 S ASPEN CT, BROKEN ARROW, OK 74012-7301
(918) 451-5143
Mailing address
2704 S ASPEN CT, BROKEN ARROW, OK 74012-7301
(918) 645-1803

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1396
OK

Other

Enumeration date
05/08/2007
Last updated
07/08/2007
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