Individual
SAM VALE PENNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
1601 ACADEMY RD, PONCA CITY, OK 74604-4409
(580) 762-0927
(580) 762-0933
Mailing address
419 E BROADWAY ST, CUSHING, OK 74023-3339
(918) 509-0967
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
675
OK
Other
Enumeration date
11/27/2012
Last updated
11/27/2012
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