Individual
LESLIE NICOLE AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1815 E SKELLY DR, TULSA, OK 74105-5949
(918) 747-4193
Mailing address
1392 E 171ST ST N, SKIATOOK, OK 74070-3121
(918) 798-6733
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1449
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA-1449
OKLAHOMA PTA LICENSURE
OK
Enumeration date
05/12/2021
Last updated
05/12/2021
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