Individual
LACY CLEVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12326 E 86TH ST N, OWASSO, OK 74055-2543
(918) 272-1923
Mailing address
14700 E 88TH PL N APT 906, OWASSO, OK 74055-4932
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2230
OK
Other
Enumeration date
03/08/2021
Last updated
07/22/2021
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