Individual
REBECCA BLOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
310 W TAFT AVE, SAPULPA, OK 74066-5437
(918) 815-3704
Mailing address
310 W TAFT AVE, SAPULPA, OK 74066-5437
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1945
OK
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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