Individual
MRS. TARA DALIS COFFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5000
(580) 379-5509
Mailing address
19826 E COUNTY ROAD 162, OLUSTEE, OK 73560-9009
(580) 477-2398
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2452
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200079640A
—
OK
Enumeration date
04/24/2007
Last updated
11/21/2023
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