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Individual

KELLI RENEE PRIDEMORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
3701 M.L.K. JR BLVD, TULSA, OK 74106
(918) 425-3583
Mailing address
419 S 276TH EAST AVE, CATOOSA, OK 74015-5535
(918) 899-8391

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary

Other

Enumeration date
09/24/2020
Last updated
03/03/2025
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