Individual
SIERRA PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
201 W MAIN ST, DAVIS, OK 73030-1749
(580) 369-3900
Mailing address
440 MERCHANT DR, NORMAN, OK 73069-6470
(405) 809-8713
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2582
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2582
PTA LICENSE
OK
Enumeration date
03/12/2021
Last updated
03/12/2021
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