Individual
JOHNATHON DAVID MILLWEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4802 S 109TH EAST AVE, TULSA, OK 74146
(580) 302-1121
Mailing address
7841 S UNION AVE APT 2203, TULSA, OK 74132-2766
(580) 302-1121
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
803
OK
Other
Enumeration date
04/03/2018
Last updated
02/26/2019
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