Individual
LARRY SIDNEY TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
1519 N OKLAHOMA AVE, SHAWNEE, OK 74804-3848
(405) 919-0135
(405) 273-7084
Mailing address
8809 S SOONER RD, STE E, OKLAHOMA CITY, OK 73135-6605
(405) 919-0135
(405) 273-7084
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1807
OK
Other
Enumeration date
04/24/2007
Last updated
01/15/2019
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