Individual
GLENN BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 436-3980
(580) 421-6283
Mailing address
1921 STONECIPHER BLVD, ADA, OK 74820
(580) 436-3980
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2009025549
MO
225100000X
Physical Therapist
Primary
4288
OK
Other
Enumeration date
10/13/2009
Last updated
07/09/2015
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