Individual
LORI BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1165 BRENNER RD, SAPULPA, OK 74066-6141
(918) 224-0600
Mailing address
1165 BRENNER RD, SAPULPA, OK 74066-6141
(918) 224-0600
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2242
OK
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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