Individual
DEJUAN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12641 S STATE HIGHWAY 51, COWETA, OK 74429-6476
(918) 486-1357
Mailing address
1440 S 124TH EAST AVE, TULSA, OK 74128-5235
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2675
OK
Other
Enumeration date
03/08/2021
Last updated
09/03/2021
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