Individual
TIM T MINNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2232 W HOUSTON ST, BROKEN ARROW, OK 74012-3529
(918) 259-9522
(918) 259-9521
Mailing address
2234 W HOUSTON ST STE B, BROKEN ARROW, OK 74012-3519
(918) 259-1888
(918) 251-3725
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2542
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076460A
—
OK
Enumeration date
07/17/2006
Last updated
04/30/2015
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