Individual
TYRE' KORDYL TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AAT
Contact information
Practice address
4808 NW 161ST ST, EDMOND, OK 73013-3205
(405) 694-9986
Mailing address
4808 NW 161ST ST, EDMOND, OK 73013-3205
(405) 694-9986
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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