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Individual

KYLA NICOLE IBARRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
817 W CHEROKEE ST, WAGONER, OK 74467-4616
(918) 485-3100
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
(812) 628-3060

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3540
OK

Other

Enumeration date
08/22/2022
Last updated
08/22/2022
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