Individual
KELLY FOSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7401 RIVERSIDE PKWY, TULSA, OK 74136-5044
(918) 417-1906
Mailing address
800 E ALBUQUERQUE ST, BROKEN ARROW, OK 74011-7245
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5474
OK
Other
Enumeration date
12/22/2020
Last updated
12/27/2020
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