Individual
LOREN WAYNE BENGTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
20355 S 4450 RD, VINITA, OK 74301-5703
(918) 256-8453
Mailing address
20355 S 4450 RD, VINITA, OK 74301-5703
(918) 256-8453
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
956
OK
Other
Enumeration date
12/29/2008
Last updated
12/29/2008
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