Individual
TIFFANY RAE PANNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6705 E 81ST ST, STE. 170, TULSA, OK 74133-4171
(918) 710-5790
Mailing address
204 W. WALNUT ST, COWETA, OK 74429
(918) 520-7661
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1674
OK
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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