Individual
MARA MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
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
Primary
5143
OK
Other
Enumeration date
09/01/2016
Last updated
07/24/2018
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